History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: November, 1944 Vancouver Medical Association Nov 30, 1944

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 The
•   •
T"_~>
BULLETIN
of the . • .
VANCOUVER
M E n|l € A L
ASSOCIATION
With Which Is Incorporated
Transactions of the
^VICTORIA MEDICAL SOCIETY^
the
VANCOUVER GENERAL HOSPITAL
and
ST. PAUL'S HOSPITAL
In This Issue:
PSYCHIATRY IN GENERAL PRACTICE—
G. H. Stevenson, M.D.   37
"FRACTURES OF THE OS CALCIS: IMPROVED
METHOD OF TREATMENT—Lt.-Col. R. I. Harris 43
THE DIAGNOSIS OF A-STEUROSIS—
Geo. A. Davidson, M.D. ! ___H' 49
EMOTIONAL PROBLEMS OF DEMOBILIZATION—
Maj.-Gen. Chisholm 53
NEWS AND NOTES j| it 55
iVOL. XXI. NO. 2
November. 1944 WITH
MINEROVITE
Jr. Bm 5.
ESTO.
VITAMINS   PLUS MINERALS
Only occasionally does one find clear-cut cases
showing deficiency in only one vitamin. Generally,
vitamin deficiencies are multiple and give rise to
a confused clinical picture very difficult to diagnose. The skin, haemopoietic, digestive, nervous
and cardiovascular systems may be involved.
When confronted with a diagnosis suggestive of
deficiency, but not clear-cut enough to indicate
positively which vitamin is lacking, a multivitamin preparation is indicated.
MINEROVITE, E.B.S. Is such a preparation, containing In
each tablet about half the recommended daily minimum of each of the vitamins known to be essential to
human health. For guidance In prescribing the proper
dose, the accompanying table, showing the compost-
tlon of Minerovite/ appears on every bottle*
INDICATED as a prophylactic vitamin and mineral supple,
ment in cases of diets restricted for reasons of allergy, peptic
ulcer or convalescence and a therapeutic remedy in cases of
hypovitaminosis.
"'TRACE ELEMENTS t Some years ago, agricultural research*
ers began to track down the cause of deficiency diseases that
affected livestock in some areas. It was found that the lack of
minute amounts of certain elements ('trace elements' they
have been called) was responsible, and several such elements
have been found, small quantities of which are essential to
healthy mammalian life. Such are the copper and manganese
incorporated in Minerovite, 100 mgs. of each, per tablet.
•Oscar Baudisch, J.A.M.A., VoL 123, Page 959
WHEN PRESCRIBING
Specify E.B.S. Preparations
JUST TO
BE SUREI
Supplied in bottles
of 100, 500 and
1,000 tablets.
C.C.T. Ne. 466
Minerovite
CBS.
°°se: Three or four
daily,
CoMfOl
^ONTO^]^
Formula C.C.T. #466 Minerovite E.B.S.
Each tablet contains:
Vitamin A _KS  .   . ,■**»_f  2500 Int. Unit*
Vitamin D .   .  j||Pf_U#: . 400 Int. Unit*
Vitamin C .   .   .   ._»-.'..  .   . 17.5mgms.
(350 Int. Units)
Vitamin K .  .  .   .^. 008 mgms.
(200 Dam Units)
Vitamin B\ (Thiamin Chloride)
.375 mgms. (125 Int. Units)
Vitamin Bt (Riboflavin) . ppi*? • .50 mgms.
Vitamin Bt (Pyridoxine
Hydrochloride) .125 mgms.
Pantothentic Acid . $M'&i^»'.125 mgms.
Niacin, g&^gi;. .^g^. ... 5.0mgms.
Combined with Salts of the following elements: Iron.Manganese.Copper and Calcium.
THE E. B. SHUTTLEWORTH CHEMICAL CO. LIMITED
TORONTO
MANUFACTURING   CHEMISTS
CANADA THE    VANCOUVER    MEDICAL    ASSOCIATION
BULLETIN
Pulished Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B.C.
EDITORIAL BOARD:
Db. J. H. MacDermot
Db. G. A. Davidson Db. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XXI.
NOVEMBER, 1944
No. 2
OFFICERS, 1944 - 1945
Db. H. H. Pitts
President
DB. FBANK TUBNBULL
Vice-President
Db. A. E. Tbites
Past President
Db. Gobdon Bueke
Hon. Treasurer
Db. J. A. McLean
Hon. Secretary
Additional Members of Executive: Db. G. A. Davidson, Db. J. R. Davies
TRUSTEES
Db. P. Bbodie Db. J. A. Gillespie Db. W. T. Lockhabt
Auditors: Messes. Plommeb, Whiting & Co.
SECTIONS
Clinical Section
Db. W. D. Keith Chairman Db. S. E. Tubvey Secretary
Eye, Ear, Nose and Throat
Db. Letth Websteb Chairman Db. Gbant Lawbence Secretary
Pediatric Section
Db. John Pitebs Chairman Db. Harry Baker Secretary
STANDING COMMITTEES
Library:
Db. S. E. C. Tubvey, Chairman; Db. F. J. Bulleb, Db. W. J. Dobbance,
Db. R. P. Kinsman, Db. J. R. Neison, Db. D. E. H. Cleveland
Publications:
Db. J. H. MaoDebmot, Chairman; Db. D. E. H. Cleveland,
Dr. G. A. Davidson, Db. J. H. B. Gbant, Db. W. D. Keith, Db. L. H. Websteb
Summer School:
Db. G. A. Davidson, Chairman; Db. J. C. Thomas, Db. R. A. Gilchbist,
Db. A. -M. Agnew, Db. L. H. Leeson, Db. L. G. Wood
Credentials:
Dr. D. E. H. Cleveland, Chairman; Db. E. A. Campbell, Dr. D. D. Fbeeze.
V. 0. N. Advisory Board:
Db. Isabel Day, Db. J. H. B. Gbant, Db. G. F. Stbong
Metropolitan Health Board Advisory Committee:
Db. W. D. Patton, Db. W. D. Kennedy, Dr. G. A. Lamont
Representative to B. C. Medical Association: Db. A. E. Tbites
Sickness and Benevolent Fund: The Pbesldent—The Tbustees
'
• ' Gratifying Relief in "Sore Throat"
with
Aspergum
When the patient chews Aspergum a soothing flow
of saliva laden with acetylsalicylic acid is released.
Thus effective analgesia is brought into immediate
and prolonged contact with all pharyngeal areas,
including those often not reached by gargling or
irrigations.
Moreover, chewing provides a gentle stimulation
of surrounding muscles, helping to relieve local
spasticity and stiffness, promoting tissue repair.
The patient is more comfortable, willingly assumes
a suitable diet earlier: convalescence is hastened.
Indications for the use of Aspergum:
1 •   Post-tonsillectomy care
2. Acute and chronic tonsillitis,
pharyngitis, "sore throat" of
influenza, "Grippe", etc.
3. Acute coryza (with accompanying pharyngeal irritation)
4. Non-specific upper-respiratory infections
Aspergum is available in packages of 16, moisture-proof bottles
of 36 and 250 tablets.
Ethically promoted—not advertised to the laity. In boxes of 16
and moisture-proof bottles of 250
tablets. Write for samples and
literature to W. Lloyd Wood,
Ltd., 64-66 Gerrard Street, East,
Toronto, Ontario.
Ifc/i Aspergum VANCOUVER HEALTH DEPARTMENT
STATISTICS—SEPTEMBER, 1944
Total Population—Estimated         299)460
Japanese Population—Estimated  Evacuated
Chinese Population—Estimated  5,728
Hindu Population—Estimated  227
Rate per 1,000
Number Population
Total  deaths     266 10.8
Japanese  deaths    Population Evacuated
Chinese   deaths           14 29.8
Deaths—residents   only        237 9.7
BIRTH REGISTRATIONS:
Male,  318;  Female,  300 '.     618 25.1
INFANT MORTALITY: Sept., 1944 Sept., 1943
Deaths under one year of age :       22 13
Death   rate—per   1,000   births       3 5.6 22.4
Stillbirths   (not included above)       13 9
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
Scarlet Fever 	
Diphtheria	
Diphtheria  Carrier  	
Chicken Pox 	
Measles   	
Rubella 	
Mumps  	
Whooping  Cough  	
Typhoid Fever	
. Undulant Fever 	
Poliomyelitis    	
Tuberculosis 	
Erysipelas	
Meningococcus  Meningitis   _
Paratyphoid Fever   (Carrier)
Infectious Jaundice 	
Typhi-murium 	
Typhi-murium   (Carrier)  	
August
, 1944
Sept.
, 1944
Oct. 1
-15, 1944
Cases
Deaths
Cases
Deaths
Cases
Deaths
19
0
20
0
10
0
0
0
~*fl* -
0
0
0
0
0
0
0
0
0
9
0
19
0
10
0
:. 3T
0
21
0
56
0
2
0
®fe
0
;&"
0
17
0
14
0
S:
0
7
0
20
1
15
0
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
46
8
87
7
25
JHpsSs
2
0
1
0
0
0
2
0
hJJ^
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
6
0
4
0
0
0
2
0
0
0
V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH
DIVISION OF VENEREAL DISEASE CONTROL
Rich- North
Vancouver mond        Vancouver       Burnaby
Syphilis   (September)          45
Gonorrhoea   (September) 103 2 s.
West
Vancouver
45
105
B 10 G LAN-A
The most effective therapy for waning mental and physical energy,
deficient concentration and memory, reduced resistance to infection,
muscular weakness and debility, neurasthenia and premature senility.
The efficacy of this very potent endocrine tonic has been confirmed by
the clinical evidence of many thousands of cases treated during
1932-1943.
Stanley N. Bayne, Representative
Phone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C.
Descriptive Literature on Request
THE SCIENTIFIC HORMONE TREATMENT
Page Thirty-two ALIKE
APPEARANCE -
::::;V..:::X:v:--V.'-
• Today, as in 1875, Squibb Cod Liver Oil is helping babies
build strong, healthy bodies. They didn't know it then—
but now most people realize that it isn't the oil itself—but
the vitamin content of the oil that counts.
Squibb Cod Liver Oil is twice as rich in vitamins A and
D as oils just meeting official pharmacopeia requirements.
Therefore your patients have to give their babies one teaspoonful only of Squibb's daily as against two teaspoonfuls
of these less potent oils.
The high quality of Squibb Cod Liver Oil is the result of
careful rendering and refining of specially selected livers.
Excessive heating and exposure to pir is avoided and the
final oil is carbonated and bottled uhder carbon dioxide to
avoid oxidation of vitamin A.
Squibb Cod Liver Oil supplies, per gram,
1800 Int. units of vitamin A and 175 Int.
units of vitamin D. It is available in 4 and
12 ounce bottles either plain or mint-
flavoured. Premature or rapidly growing
infants need extra vitamin D and should
therefore receive Squibb Cod Liver Oil
with Viosterol 10D, which contains 3000
Int. units of vitamin A and 400 Int. units
of vitamin D per gram.
Tiny bodies, externally
alike, may differ basically In their requirements
of Vitamin sto: That is
why Squibb Co<r liver
Oil comet in two potencies—Squibb Cod Liver
Oil for normal babies
and Squibb Cod liver
Oil with Viosterol 10D
for premature or rapidly
growing infants.
__g_OH?
SW^!™^,_i_S-
l__i&S___S_£
eOU*S$
«_ V<—xwi-tv:
«t>
For literature write
i. R. Squibb & Sons of Canada Ltd.
36-48 Caledonia Road, Toronto. VANCOUVER     MEDICAL     ASSOCIATION
FOUNDED 1898
INCORPORATED 1906
PROGRAMME OF THE FORTY-SEVENTH
| ANNUAL SESSION |,        ff
GENERAL MEETINGS will be held on the first Tuesday of the month at 8:00 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month at 8:00 p.m.
These meetings will continue to be amalgamated with the clinical staff meetings of
the various hospitals for the coming year. Place of meeting will appear on the agenda.
General meetings will conform to the following order:
8:00 p.m.      Business as per agenda.
9:00 p.m.      Paper of the evening.
January    2—GENERAL MEETING: Cancelled.
January 1*5—COMBINED   CLINICAL   MEETING   AND   STAFF   MEETING   AT
VANCOUVER GENERAL HOSPITAL.
February    6—GENERAL MEETING:
Carcinoma of the Cervix—Dr. Ethlyn Trapp.
Late Manifestations—Urological- -Dr. L. R. Williams.
Rectal—Dr. A. T. Henry.
Neurological—Dr. Frank Turnbull.
February 20—COMBINED  CLINICAL MEETING  AND   STAFF  MEETING  AT
ST. PAUL'S HOSPITAL.
March    6—OSLER LECTURE.
March 20—COMBINED   CLINICAL   MEETING   AND   STAFF   MEETING   AT
VANCOUVER GENERAL HOSPITAL.
April    3—GENERAL MEETING: Penicillin Therapy.
Discussion to be led by Major W. W. Simpson, R.C.A.M.C.
April 17—COMBINED CLINICAL MEETING AND STAFF MEETING AT ST.
PAUL'S HOSPITAL.
May    1—ANNUAL MEETING.
dimfrr $c i|amta Eft.
ESTABLISHED 1893
VANCOUVER, B. C.
North Vancouver, B. C.
Powell River, B. C.
Pega Thirty-three
i PENICILLIN .
To assure that Penicillin would be available for the needs
of the Armed Services of Canada, the Dominion Government
made possible, a year ago, the establishing of two production
plants, one of which was in the Connaught Laboratories.
Production was commenced in the Connaught Laboratories
within seven months and today large quantities of Penicillin
of high quality are being produced.
The entire amount of Penicillin produced in the Connaught
Laboratories is allocated to the Armed Services.
As soon as circumstances permit, Penicillin prepared by
the Connaught Laboratories will be available for civilian
distribution in Canada.
CONNAUGHT LABORATORIES
University of Toronto    Toronto 5, Canada
DEPOT FOR BRITISH COLUMBIA
MACDONALD'S PRESCRIPTIONS LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. THE EDITOR'S   PAGE
At the last Annual Meeting of the British Columbia Medical Association, a most significant report was read by the Chairman of the Committee appointed to consider the
question-of a Medical School for British Columbia. The 1945 Session of the Legislature
of the Province meets in January or February of next year, and we feel that something
should be said about this, so that we may enlist as active workers towards this end, not
only those who understand and appreciate the need for it, not only those medical men
who live in or near Vancouver, but every medical man in the Province, every member of
the Legislature, every educational leader, and last, but by no means least, the public at
large, who will ultimately have to bear the cost—and who must be shown how great the
need is, not only from our point of view, but even more from their own.
The urgency of the case is beyond question. We hear on every side of the plans
that are being drawn up for social betterment, and we welcome and applaud these suggestions—we know, indeed, that they are long overdue. We know that the public is
right in insisting on more and better medical service—on greater social security, on
more efficient prevention of disease, mental hygiene measures ,and a more even distribution of our medical resources. And we know that if all this is to be accomplished
on any reasonably satisfactory scale, the presently available number of doctors is altogether too far below the number that will be needed. Nor is it going to be possible to
staff the positions necessary from any source of supply that we now have of medical men.
The medical schools now in existence in Canada cannot begin to turn out medical graduates in sufficient number.
It takes years to make a doctor, and we cannot get started too soon. Even if several
medical schools opened their doors tomorrow, it would be a long time before the effect
would be felt. Therefore time is "of the essence of the contract," and we should be
thinking in terms of speed.
British Columbia is especially in need of a school. We need not at this juncture
labour the point so clearly made by our Committee, that Eastern schools are finding it
impossible to allot enough vacancies to candidates from British Columbia, that our
young men are losing opportunities that should be theirs. Both Canada and British
Columbia suffer from this fact.   The only remedy is to start one of our own.
It would seem, in view of the physical conditions, that Vancouver is the logical
place, in fact the only place at present, where a medical school can be built at present,
which would offer facilities of training. This is not to say that only in Vancouver
should there ever be a medical school. British Columbia is growing, and there would
seem to be no reason why ultimately another excellent school should not be built elsewhere—e.g., Victoria, with its good hospitals and its steadily developing medical facilities.   When that day comes, we should give it our utmost support.
Meantime, Vancouver must be regarded in this matter, not as the City of Vancouver, but as a suitable site for the British Columbia Medical School. This will, of
course, be best attached to the University of British Columbia, not necessarily entirely
situated within the campus of that institution as at present—for obvious reasons of
clinical teaching—but under the jurisdiction, and within the corporate structure, of the
University.
We shall be told, ad nauseam, of the difficulties that exist, of the needs of other
faculties, of the desirability of a law school, of the lack of money to satisfy everybody.
In this matter we do not think any of the arguments are sound. Is there a crying
need for a Medical School? There is. Have we the facilities and the material and personnel to establish a first class Medical School? We have, as nobody could doubt who
sees the excellent hospital f acuities and possible material in the way of lecturers, teachers,
Page Thirty-four which are already available to be drawn on, and which could easily be supplemented
from other sources if the opportunity were given.
We are apt to be too much impressed by size. Vancouver is not in the miUion-
population class, but we may do well to remember that Montreal and Toronto were
turning out excellently trained doctors when they were not nearly as big, and had nothing
like the hospital sources of clinical materials that we have—that Winnipeg, which is
not as big as we are, has for a generation and more been giving a training in medicine
second to none; that Edmonton, with less than half our population, is doing the same.
We should have had a school here twenty years ago.
The need is urgent, and the money can and must be found. But we must make
the need plain, and the medical men of the province are the ones who can and must do
this. Every medical man in British Columbia should be behind this, should preach it in
and out of season, should importune those in authority, and "wear out the doorsteps of
their houses" doing this.
We quoted Dr. McPhedran of the Canadian Medical Association in this matter, when
he told us that we must ourselves sell this scheme to the public, and be propagandists and
teachers. We may also quote Dr. Herman L. Kretschmer, President of the American
Medical Association, who stressed the fact, in addressing the House of Delegates at the
A.M.A. meeting that "practising physicians" (not, mark you, Committees, or the Council of the College, or the Secretaries of the various Associations) "should devote at least
two hours a day to educating the public. . . ." "The physician should serve as his own
public relations man within the profession."
Dr. Eben J. Carey, Dean of Marquette University School of Medicine, says, "The
medical education of the public is not the responsibility of the politician, but of the
members of the medical profession."
With all this we thoroughly agree. The Bulletin hopes at an early date to go
more deeply into this matter. In the meantime, we urge our readers to read and reread
the parable of the Importunate Widow and to remember that homely proverb, "The
hinge that squeaks gets the grease."
LIBRARY NOTES
RECENT ACCESSIONS TO LIBRARY—
Surgical Clinics of North America, Symposium on Cancer, Barnard Hospital Number,
St. Louis, October, 1944.
Manual of Military Neuropsychiatry,   1944,  by Harry C.  Solomon  and  Paul I.
Yakovlev.
Transactions of the Ophthalmological Society of the United Kingdom, Vol.  63,
Session, 1943.
Autonomic Regulations, 1943, by Ernest Gellhorn.
Gastro-Enterology, Vols. 1 and 2, 1943, by Henry L. Bockus.
Text-Book of Ophthalmology, Vol. 2, by Sir W. Stewart Duke-Elder.
Intravenous Anaesthesia, 1944, by Richard C. Adams.
SPECIAL SUPPLEMENTS—
Special issues of two well-known journals will be received with much interest. The
British Journal of Surgery has published an extra number, devoted to Pemcillin in Warfare. A wide range of cases is reported by members of the British and U. S. Army
Medical Staffs, and these are taken from experiences in various theatres of war. The
introductory articles include one on "The Principles of Penicillin Therapy," by H. W.
Florey and M. A. Jennings, and one on "Bacteriological Methods in Connection with
Penicillin Treatment," by L. P. Garrod and N. G. Heatley. The two concluding
articles cover penicillin therapy in gonorrhoea and syphilis.
The American Journal of Ophthalmology has issued a second section to their October
number, which contains the sixth de Schweinitz Lecture of the College of Physicians of
Page Thirty-five Philadelphia, Section on Ophthalmology, given by Henry C. Haden. The title is, "Concerning the Relations of the Developing Optic Nerve to the Recessus Opticus and the
Hypophysis in Young Foetuses: A Study of Seven Human Foetuses 4 M. M. to 40 M. M.,
Inclusive." Forty-one illustrations, which compose the major part of the publication,
were made from unretouched photographs of sections of human embryos and foetuses in
Dr. Haden's private collection.
DOCTOR BAGNALL AND THE MEDICAL LIBRARY
In 1920 the Library of the Vancouver Medical Association was in its early adolescence
when an event that was to mould its future for twenty-five years occurred. Wallace
Bagnall was elected to the Committee in charge of the Library.
The greatest event in the development of the Library prior to this had been the
donational benediction of Sir William Osier, with his fervent insistence on the importance of a library in the medical community. Doctor Bagnall believed in this almost to
the point of fanaticism and gave of his time, energy and ability more than most physicians realized. It would surprise most of us to know that at least every other book in
our library had been chosen by Doctor Bagnall; it would amaze us still more to know
that he believed our library to be wholly inadequate for the cultural needs of a medical
fraternity; but it would not astound those of us who worked with him that he envisaged
a scientific library that would give British Columbia an access to all branches of science.
His views on the development of our library were such that physicians were wont to
dismiss him as a visionary. He deplored the inadequate physical accommodation, the
popular or democratic election of men often little interested in, or qualified to be a
judge of, the upkeep or growth of a library, and the lack of general appreciation of the'
'influence of a library on the quality of medical practice. He dreamed of a general
medical library serving not only our Association but the University, our medical school
and the province at large—a physicians' club with lunch and tea rooms, a common
meeting place dominated by the intellectual influence of an eclectic library.
His help to the library was not only advisory or theoretical. He rarely missed a
meeting of the committee, even in the last year when he might well have rested to
advantage, he spent evenings in sorting out and discarding the dross and superfluous
from the huge numbers of books that have long been gathering dust in the cellar of the
library. With a tenacity that at times could become a downright annoyance, he insisted
on buying books in research, in the auxiliary sciences, and in cultural subjects. His
cutting retort to any objections would be that, even if older ones were not reading
these books, younger and better men were coming along and the material must be here
for them.
Osier has said, "In the continual remembrance of a glorious past, individuals as well
as nations find their noblest inspiration." One of the greatest legacies of our profession
is the memory of great physicians in each community. For sustained interest, continuity
of effort, idealism and realism nicely balanced, and avoidance of all personal publicity,
this was one of our community's greatest physicians. His "understanding was keen,
skeptical, inexhaustibly fertile in distinctions and objections; his taste refined; his temper
placid and forgiving, but fastidious, and by no means prone to malevolence or to enthusiastic admiration."
This is a poor expression of the affection and respect in which the Committee of your
Library held Doctor Bagnall, but in the near future, we shall give you the opportunity
to participate in a development in your library which will commemorate the Bagnallian
tradition and hopes in such a manner that, were Doctor Bagnall here, he would say,
"Well done."
—The Library Committee.
Page Thirty-six British  Columbia  Medical  Association
(Canadian Medical Association, British Columbia Division)
President Dr. G. O. Matthews, Vancouver
First Vice-President Dr. A. H. Meneely, Nanaimo
Second Vice-President  Dr. Ethlyn Trapp, Vancouver
Honorary Secretary-Treasurer : I Dr. S. G. Baldwin, Vancouver
Immediate Past President Dr. P. A. C. Cousland, Victoria
PSYCHIATRY IN GENERAL PRACTICE
By Dr. G. H. Stevenson (Toronto)
Read at British Columbia Medical Association Annual Meeting.
Perhaps a slight change of one letter should be made in the title of this paper to
make it read—"Psychiatry Is General Practice" rather than "Psychiatry in General
Practice."
I offer this suggestion seriously because of the growing appreciation that general
practice is not limited only to the physical abnormalities that afflict us, those caused by
physical etiology, bacteria, toxaemias, degeneration, etc. The physical field is no small
field and a thorough training in these aspects is no small achievement, but its boundaries have been extended by a new dimension—the emotional factors in disease and
health. True, physicians have perhaps always recognized that there were mental elements
in physical disease, such as the effect of the attitude of the patient to his disease as
affecting its outcome. He knew that worry often seemed to have an adverse effect on
the well-being of the individual. He remembered that Crile thirty years ago demonstrated that certain hyperthyroid cases recovered without operation when relieved of
their domestic or economic problems. He knew that his own psychological approach to
a patient was important in maintaining the confidence of the patient in hirn and helping
the patient toward recovery. It may sometimes have facetiously been referred to by
others as "the bedside manner" but actually he was including a form of psychotherapy
in his treatment programme.
In 1920 Professor Walter B. Cannon of Harvard published his monumental work
"Bodily Changes in Pain, Hunger, Fear and Rage," in which he showed how stormy:
emotions, operating through the sympathetic nervous system, produced in experimental
animals the effects of increased blood sugar, rapid hearts, elevation of blood pressure,
decreased production of digestive juices, arrested digestion and inhibition of peristalsis.
Valuable as these effects may be to us and to lower animals in times of great danger, to
enable the animal to fight better or to run faster, tney nevertheless become a handicap
and an interference to the welfare of the animal if they continue when the need no
longer exists. And yet so many of our patients come to us with sleeplessness, digestive
disorders, cardiac complaints, which if analyzed thoroughly, may prove to be due to
continued emotional conflicts and disturbances, rather than to any disease of the body
itself.
In 1935 Helen Dunbar brought together in one volume, "Emotions and Bodily
Change," practically everything that had been published on this subject. It is still the
basic reference work in this field.
In the intervening years much additional work has been published showing the
interplay of the mental and physical, leading to the coining of a new word to express
this body-mind relationship, the word "psychosomatic." An organization for research
in psychosomatic medicine has been formed, the Journal of Psychosomatic Medicine is
Page Thirty-seven published regularly. Since 1939, Weiss and English have published the first edition of
a textbook on psychosomatic medicine. A new volume by Dunbar entitled "Psychosomatic Diagnosis" has been published within the past year.
The present war as well as World War I enlarged our knowledge of psychosomatic
medicine. World War I emphasized in great numbers of cases what we already knew
less frequently in civilian life, that conflicting emotions of fear for one's safety and
desire to be a brave soldier, produced so-called shell-shock in predisposed individuals.
The present war has shown the effect of anxiety, homesickness and discontent in producing peptic ulcer as at least a large part of the etiology. Neurocirculatory asthenia
with its multiform physical symptoms is now recognized as a neurosis with somewhat
similar emotional origin. Perhaps psychosomatic medicine is beng overworked, perhaps
too much is being claimed for it, but at least the general practitioner, to be fair to his
patients and himself, must in many cases weigh the contribution of emotional factors
in the causation of disease. Even such a general condition as fatigue may well be the
expression of discouragement with the problems and responsibilities of life, indefinite
pains, pelvic or elsewhere, may represent a psychic pain, as so commonly expressed in
such phrases as "he gets under my skin" or "he gives me a pain in the neck." Nausea
and vomiting may be the somatic equivalent of psychic repulsion to distasteful life
situations. Some of these symptoms, referable to the abdomen, can simulate gall-bladder
or appendicial disease and lead to unnecessary surgery.
A good general rule in the neuroses and the psychoses is to avoid surgery unless you
have good reason to believe that the morbid condition is causing the mental illness and
only then if other means have failed. Neuroses cannot be removed surgically but can
be made worse by surgery. While focal infections, readily accessible, should be cleaned
up by minor surgery, such as infected teeth, tonsils and sinuses, it is often definitely
hazardous to open an abdomen without clear evidence of definite inflammation or other
definite morbid process. Unless a retroverted uterus is definitely producing physical distress it may be much better to leave it surgically undisturbed; even hernias are best left
linoperated, especially in middle, life, unless they are more of a hazard and handicap to
the patient than they commonly are. Within the past year I have seen a doctor with a
history of two previous manic attacks develop a third attack immediately after herniotomy, and a bank manager, mildly neurasthenic, enter a deep depression and attempt
suicide after the same operation. The mental changes accompanying hyperthyroidism
may be rendered still more severe by surgical removal of the thyroid rather than by
mdical treatment and psychotherapy.
Before leaving the matter of surgery in mental medicine I should like to refer to a
surgical procedure of fairly recent development known as prefrontal lobotomy or
kucotomy. Originated in France by Moniz some ten years ago, it was brought to this
continent by Freeman and Watts, who have performed this operation frequently and
published a volume concerning it by the title of "Psychosurgery." The operation is of
special value in the agitated depressions of middle or later life which have failed to benefit
by more conservative treatment. It consists in a trephine bilateral in the line of the
coronal suture, and a severance of the tracts between the hypothalamus and the prefrontal areas of the brain. It does not appear to affect the intellectual capacity of the
individual, but in selected cases the disappearance of worry and agitation are phenomenal,
with good gain in weight and varying degrees of return to a good social and occupational
adjustment. Dr. K. C. McKenzie of Toronto has operated on approximately 25 cases,
5 of whom have been patients of the hospital to which I am attached. Only one of our
five is unimproved, a case of schizophrenia; four, suffering from involution melancholia,
were able to return to their homes immediately after convalescence, in spite of several
years of previous mental hospitalization and all four continue at home.
To return more closely to general medicine and psychiatry, I should like to caution
practitioners as to the dangers of bromide administration in the actual causation of
psychoses. The bromjdes have won a valued place in our pharmaceutical treatment of
many conditions, but in addition to the gastric and skin conditions they sometimes
Page Thirty-eight cause, they may also produce a state of cerebral intoxication. Given to relieve sleeplessness, so-called "nervousness" and other psychic disturbances, they may actually increase the symptoms to the degree of marked mental confusion and hallucinosis. Every
mental hospital admits patients who would not have become admitted or become
psychotic had the bromide tolerance and blood concentration of bromides been closely
watched. Some patients may of their own accord take larger doses than prescribed and
others may get their bromides through drug store purchase, but only too frequently the
patient has taken the drug under medical direction. Commonly the people who develop
a bromide delirium have kidney damage which inhibits the usual excretion rate and
permits the bromides to accumulate in the bloodstream. Treatment depends on early
diagnosis, immediate discontinuance of bromides, and the administration of common
salt, 30-grain capsules, thrice daily until the bromide concentration is reduced well
below the toxic level, which is usually 150 milligrams per cent.
This might be a good place to interject the suggestion that we drop the old term
insanity and replace it, not by mental illness 'or psychosis, but delirium. As long as
we think of the term insanity we are apt to think of something outside the field of
general medicine. These terms all mean that the individual has experienced a mental
change, from whatever cause or causes, of such an extent that he is unable to think
clearly and coherently, he may have delusions and hallucinations and is unable to govern
his conduct in a socially satisfactory manner. The common practice has been to think
of delirium as of short duration and due to toxic or traumatic factors, and insanity as
of long duration. This is not a very logical differentiation and I suggest no differentiation is indicated. So-called insanity or psychosis is merely a longer than usual delirium,
a still unrecovered delirium, and is still within the province of the general practitioner.
A case in point might be the so-called puerperal psychoses. These distressing conditions following some confinements are due chiefly to toxic and debilitating factors on
the one hand, or to emotional factors on the other, perhaps a combination of the two.
The patient is delirious. If toxic she may clear up quickly under treatment, but it may
not be a toxic delirium. It may be a manic-depressive delirium, which will last longer
but will terminate in recovery, or it will be a schizophrenic delirium, which only too
frequently runs a malignantly deteriorative course, to chronic dementia. But even in
this last case the patient is still delirious perhaps years after the birth of her child and
still a challenge to our research and our best and untiring therapeutic efforts.
While criticizing the use of the words insanity or psychosis, might I also suggest we
discontinue use of the term "nervous breakdown." This is usually applied to the non-
delirious mental disorders, the neuroses. But there is no nervous tissue pathology in
these cases and certainly it is not broken down. People sometimes like to hide behind
their "nervous-breakdowns," so-called, or take pride in them, aided and abetted at times
by their medical practitioner. I suggest we call them by their correct name, emotional
disturbances or disorders, which immediately puts some responsibility on the patient for
controlling or regulating his emotional reactions to make them less likely to cause
invalidism.
Distturbances of sleep are common in emotional disturbances, often being the early
symptoms. While we do have to treat symptoms as they arise, I would suggest we not
pay too much attention to the control of this particular symptom but concern outselves
more with the underlying factors which have produced it. The patient doubtless will
be greatly worried about his poor sleep and will insist on "sleeping medicine." His
preoccupation with his sleep difficulty may be screening his real emotional conflict, and
it is much easier to prescribe a hypnotic than to find the time in these busy days to
thoroughly analyze his psychological problem. The administration of hypnotics by
themselves, however, will not solve the problem, although affording temporary symptomatic relief. The danger of a bromide delirium I have already referred to. The patient
may become addicted to hypnotics and we may find we then have an addiction problem
also to treat. Some of them lose their ability to produce sleep except in increasing
dosage with the possibility of damage to kidneys and also interfere with the clarity of
Page Thirty-nine the patient's thinking. Remember, too, and tell your sleepless patient that nature will
see that we get enough sleep, even though it may be light and frequently broken.
Patients often claim they have not "slept a wink" but the observant nurse will record
the fact that the patient perhaps did sleep for varying periods of time. The patient is
not telling a falsehood, but the sleep being light and broken gives hirn the impression
that he has been awake all night. Hypnotics should be exhibited only in the face of
real need and if used should be discontinued speedily. A warm bath at bedtime, a light
easily digested lunch, a quiet comfortable bed, persuasion and perseverance, with more
attention to the underlying psychopathology might be thought of as a general regime
in such cases.
Some of these symptoms of sleeplessness may be a part of the menopausal syndrome.
I do not propose to enter this field except to refer to those cases of serious menopausal
depression commonly known as involution melancholia. Although progress is being
made with endocrine therapy we all know its results are none too satisfactory as yet.
We still have a lot to learn and many improvements and refinements yet to be made in it.
I imagine, however, that the symptom of "depression" can cause a great deal of
anxiety to the physician in general practice. Normal depressions can be sufficiently
worrying, but the patient depressed and on the borderline between normalcy and a
psychosis, presents a very difficult problem. You will urge constant nursing care, of
course, twenty-four hours a day, the secure locking or removal of poisons, antiseptics,
guns, sharp-pointed instruments, ropes, etc. But there are always wells and cisterns or
nearby streams, or a person can jump from a window or rooftop. She can tie belts or
sheeting around her neck. If you advise immediate removal to a mental hospital the
relatives may feel you are too hasty. If you delay, you may have a suicide and be
blamed for not having taken such action. The welfare of the patient is, of course, the
only criterion which should guide us, and removal to a mental hospital should not be
delayed if constant skilled supervision is not available or if the patient does not show
good response to treatment. A family history of suicidal attempts or of depressive
psychotic reactions may be a valuable help to us in making our decision.
I have just spoken as if there was no alternative between home nursing and the
mental hospital in such cases, but there should be an intermediate facility, namely the
psychiatric ward in the general hospital. This has been a development of the last twenty
years in the United States, more particularly in the last ten, and we are making a slow
beginning in Canada. True, you have had the psychopathic division of the Winnipeg
General under the able direction of Dr. Mathers for many years. Toronto has had the
Psychiatric Hospital. But every general hospital of fifty beds should have a small well-
equipped psychiatric section, not only for observation but for protection of the patient
and for at least preliminary treatment. A general hospital is not doing its full duty to
the sick public if it refuses the delirious patient. Even the smallest general hospital
should have a room or two (not in the basement or in a corner off the laundry) but
close enough to the other wards for good nursing, treatment and availability of consultants. Victoria General Hospital in London has recently opened a 13-bed psycho-
medical ward with continuous hydrotherapy, electrotherapy, occupational therapy,
dietetic facilities and skilled nursing. The ward is under the direction of the Chief in
Medicine as one of his medical wards, treatment being directed by the psychiatrist on his
staff. I cannot urge too strongly the importance of such a ward for the welfare not
only of depressed patients but of any other psychiatric or psychosomatic problems occur
ring in general practice.
I have referred to electrotherapy as one of the facilities on this ward and it is now a
standard in most mental hospitals. Time does not permit an extended review of
"shock" therapy, but I think "shock" therapy has been the most useful and promising
therapy in psychiatric practice in the last twenty years. Beginning with insulin hypoglycemic shock, then metrazol convulsive therapy, we have now come to favour electric
shock as able to do therapeutically what these others did, and with fewer complications
and much greater ease of administration.   The rationale is still unknown but the effects,
Page Forty
i particularly in involution melancholia, at times verge on the miraculous. In those
patients who may not respond to this therapy, prefrontal lobotomy, referred to earlier
in this paper, still offers one more valuable therapeutic prospect.
Before leaving involutional melancholia it might be noted that men may also go
through an involution, usually later than in women, at fifty to fifty-five, with feelings
of depression, discouragement, fear of psychosis, sexual impotence or reduced virility,
insomnia and gastric disturbances. This may be called neurasthenia, but it might just
as well be called the male climacteric and treated accordingly.
The largest psychiatric field is of courses the neuroses. Freud has said that the
neurosis is the price we pay for civilization, and as it is a poor sort of civilization we
have, it hardly seems worth the price. But the great mass of us have our neurotic tendencies and your offices have many people coming for help for these conditions. They
are the greatest problem of Army psychiatrists as selection problems, and constitute the
largest group of neuropsychiatric casualties. At one time many doctors, after exarnin-
ing a patient who complained of cardiac or gastric -symptoms, and finding no organic
pathology, might say he had nothing wrong with him, or he only imagines he is sick,
or he is only a neurotic. None of these three statements would be a correct statement.
If a person has symptoms which interfere with his adjustment to life he is sick, but the
etiology may be psychic and environmental and not organic or bacterial, or, as indicated
at the beginning of this paper, it may be a combination of the two. The symptomatology
may be variable depending on the type of stress and the make-up of the individual, but
each case calls for complete study of the family history, the life history of the individual, his problems, conflicts and adjustment difficulties and a careful physical examination. Correction of the psychic and environmental aspects of his life may yield high
dividends in better health.    The general practitioner may well be his own psychiatrist.
This presupposes some knowledge of psychotherapy, which means the use of mental
influence in treatment. Although whole textbooks have been written on psychotherapy,
and although some specialists concentrate on one form of psychotherapy, and scorn
others, for those of us who take a middle of the road position, such extremes need not
alarm us. Billings in his excellent little book "Elementary Psychobiology and Psychiatry" has a good outline which might be summarized as follows:
Symptomatic palliative measures, a building up physically by rest, diet, correction of
physical handicaps, cultivation of new interests. In a more direct way an attempt is
made to manage both the external environment and correct personality weaknesses.
Careful analysis of all factors, positive suggestion, direction and re-education of the
personality are then attempted. These general principles should also apply to the treatment of alcoholism, a neurosis not uncommon in men. Compulsive drinking (alcoholism) and drug addiction if viewed as psychoneurotic illnesses rather than as moral
lapses, fall definitely within the scope of the practitioner. There is as yet no pharmacological or surgical treatment for these conditions but careful psychotherapy and adequate after-care yield better results than commonly thought.
I have suggested that psychiatry is not a specialty but rather a new dimension to
general practice. Whether or not it is correct to say that psychiatry is general practice,
at least I believe it is true to say that general practice certainly should include psychiatry.
Preventive psychiatry or mental hygiene is the positive aspect of health education,
the prevention of mental ill health and the preservation of good mental health. Here
again the general practitioner has a similar responsibility as he has in the physical field
for keeping the child or adult physically fit and warding off smallpox, diphtheria and
typhoid by immunization. Perhaps practitioners generally may not feel too confident of
their ability in the mental hygiene field, but I suggest they should familiarize themselves
with it, so that they may give leadership to teachers and the general public in building
up a more mentally healthy public than now exists. Time does not permit a discussion
of mental hygiene principles here but I am prepared to review them with you if and
when a suitable hour can be found.   There are many good texts on the subject, some of
Page Forty-one them by Canadians. The Canadian National Committee for Mental Hygiene, 111 St.
George Street, Toronto, is prepared to supply lists of reading material on request.
The general practitioner might also engage in research in psychiatry. One remembers that Sir James Mackenzie made his studies in cardiology while in general practice.
All the people who enter mental hospitals have been under your care before corning to
the mental hospital. Nearly 30% of our admissions are the result of cerebral arteriosclerosis and so-called senility. Why should this be? Why should our brains wear out
so much sooner than our hearts? You might have some observations over a period of
years that would establish another mental hygiene principle and enable many more
people to maintain good mental health until their hearts stop beating. Your experience
with endocrines and other chemical agents if carefully noted should also be helpful.
Nor should you send your early deliria to the mental hospital (unless too acute to care
for safely locally), until you have attempted treatment (perhaps with the consulting
service of the Provincial mental health clinic service).
It is worth noting that with the exception of senile and cerebral arteriosclerotic
psychoses, all other psychoses are either declining or maintaining the same level as for
many years past. The general practitioner has a large place in the treatment of psychosomatic disorders and the improvement of good mental health.
• v.
PAINLESS INTRAVENOUS TECHNIQUE
Try the use of an intradermal wheel of novo-
caine adrninistered with a fine needle, as a prelude
to removing blood specimens or ao_ninistering
arsenicals. Patients will be grateful. This technique will permit you to prod around for difficult
veins. Patients won't disappear after the first
"shot"—never to return.
HlEFS
;;-
LATENT SYPHILIS—AN "EXCLUSION" DIAGNOSIS
All syphilis is latent at some time in its course. Most syphilis is latent at any given
time. Diagnosis is established by:
(1) Repeated positive blood tests.
(2) No clinical evidence of disease.
(3) C.S.F. negative.
(4) X-ray heart and great vessels negative.
(5) Supportive historical evidence of syphilis.
(6) Supportive epidemiological evidence of syphilis.
(7) Exclusion of conditions causing False Positive tests!
*       *       *       *
CONTACT INVESTIGATION
Somewhere in the community there is at least one contact associated with each V.D.
patient's infection.
The physician's most important duty is to arrange for this contact to be examined.
The physician and his patient may determine the fate of many.
Where possible, the patient should arrange to bring his or her contact in for investigation.
If this is not feasible, identifying information concerning the contact should be
passed to the Health Department for discreet, confidential investigation by specially
qualified workers.
"FIND V.D. CONTACTS — REPORT V.D. CASES."
Page Forty-two Vancouver Medical Association
"FRACTURES OF THE OS CALCIS: IMPROVED METHODS
| OF TREATMENT" f **??
By Lt.-Col. R. I. Harris
Read at Vancouver Medical Association Summer School.
The management of fractures of the os calcis is difficult. There are several reasons
for this. First, the damage to the os calcis varies within the widest limits from an
insignificant fissure without displacement to the most extreme degree of comminution
with gross deformity. Such variation of injury makes standardization of treatment
impossible. Secondly, the technical problems involved in reduction of the fracture are
complex and difficult to solve. Thirdly, involvement of the subastragaloid joint is
frequent. When this occurs, late disability from pain is inevitable even though a reasonably good reduction is obtained.
In so difficult and complex a problem it is not surprising that much difference of
opinion exists regarding the best form of treatment, nor is it surprising that the results
are often unsatisfactory.
In civil life, fractures of the os calcis are mostly the result of industrial accidents,
falls from a height, from jumping down oh to hard floors or pavements, resulting in
fractures. But the fracture has become one of great importance in this war. In fact,
it has become almost the characteristic fracture of this war.
At this point I will show you some slides. Here, for instance, is the X-ray of the
heel of an airman who received this injury to his os calcis. That type of injury; viz.,
a powerful force applied from below, has in this war produced innumerable fractures of
the os calcis. Sailors on board ship, whose ship has been torpedoed or mined, sustain the
injury by reason of the fact that the deck of the ship is forced up against their heels
and this produces fractures of the os calcis. Soldiers, driving vehicles over recently
captured fields, run into land mines and the floor of the vehicle is driven against their
heels, or sailors sliding down the sloping sides of a sinking ship go up hard against the
bilge of the ship and suffer a fracture of the os calcis.
Not infrequently in these war casualties, the fracture of the os calcis is combined with
compression fractures of the vertebral column, so we have, at this particular moment,
ample reason for devoting a little time to this subject.
I must say that in war casualties the problem has not been very satisfactory there,
the chief reason being that in the forward area the facilities for dealing with this fracture
in an adequate fashion all too often don't exist. It requires some equipment which is
not standard in army hospitals and which will demand the ingenuity of the surgeon to
improvise what he can. More important, it requires the interest of someone who knows
something about fractures of the os calcis. By the time the man gets back to the general hospital where we may find instruments and staff capable of handling the problem, it
is too late because union of some sort has already begun. And all too often this problem
of organization of treatment for specialized problems, of which fractures of the os calcis
are one, leads to that kind of imperfect result. The other kind of thing is that in the
management of fractures, particularly difficult complex problems, there is a moment
early in their course when skilled treatment by those who are experienced can do the
most for the fracture, but if that moment passes, then the improvement which could
have been obtained by skilled treatment cannot be gained even though the patient later
is placed in the hands of those experienced with it. We must remember that not only
are there certain problems which -need expert help, but in order to gain the best from
their skill they must be able to deal with them before it is too late.
Page Forty-three In civil life, the Workmen's Compensation Board knows perhaps as much about this
injury as anybody else. Here, for instance, are records supplied me by Dr. Bell of the
W.C.B. in Ontario of some sixty consecutive cases of fractures of the os calcis, indicating the duration of total disability, which meant the time lost from the moment of
the accident until the man returned to work, and you will notice how long is the period
of disability. It ranged from a month in an insignificant case, to a large group, the
majority of which were from 7, 8, 9, 10 to 12 months away from work. The great
majority of cases were back to work within 15 months, but that is a long period of disablement for this rather simple fracture. Of these 60 cases, most of them were left
with some partial permanent disability, necessitating compensation. Thirty-five were
placed on pensions varying from 3% to 50%. The remainder received compensation.
Not one case reached a finality with no disability at all. The average cost was great—
$1350 per patient.
The most important landmark in our treatment of fractures of the os calcis has been
Boehler's contribution and his work has done more than anything else to improve our
management of fractures of the os calcis. ILis emphasis upon the multiplicity of fractures, each of which requires individual treatment, and his emphasis on the need for
restoration of the bone to its normal shape, and of the value of traction in securing this,
has greatly advanced our knowledge of treatment. Perhaps most important of all has
been the stimulus he has given to the thought and study of this particular problem, but
in spite of this the problem is too often poorly managed. Many cases are still treated
with simple plaster and fixation without any plan of restoration of he bone. His plan
of treatment falls shrt of perfection, though, and on several points. First, his assumption that fractures of the os calcis can be dealt with by traction alone.
The traction is applied by a pin through the crest of the tibia and a pin through the
posterior-superior corner of the heel, and is applied first in a certain direction and
with a certain force and then the direction of the pull is changed and the pull is applied
again and again with a certain amount of force, and having pulled in these two directions, a plaster is applied incorporating the bones in the plaster. The assumption is that
if we apply this traction in two directions and with a predetermined force, that we can
expect any fracture of the os calcis to be reduced. The second difficulty in Boehler's
management is that there is no provision for determining as we go along how we are
getting along with the fracture. No X-ray is taken and the fluoroscope is not used.
Like any other fracture, these fractures need the assistance that we can obtain during
the process of reduction. Fractures of the os calcis vary from one another so much
that it is impossible to areat them with a rigidly formulated plan without X-ray.
The third shortcoming is the assumption that the deformity of the fractured bone
can be corrected by traction alone. It has been my experience that while traction,
applied as Boehler recommends, or better still applied somewhat differently, is a very
important agent in the management of fractures of the os calcis, there are certain
types of fracture in which no amount of traction applied with whatever force you wish
and in whatever direction you wish, will completely reduce the fracture, and this is
particularly true when a large fragment carrying the posterior facet of the subastragaloid
joint is depressed into the body of the bone. The traction which is applied does not
often elevate that fragment.   It needs something more than this to do it.
Finally, I think that Boehler has not laid sufficient stress upon the necessity for
fusion of the subastragaloid joint in certain types of fractures of the os calcis. There
are important reasons why this fusion should be undertaken. To begin with, the fracture often results in extensive conxminution of the bone, and this frequently involves
the articular facet of the os calcis, and when that is so it is seldom that we achieve
the perfection of reduction that will restore that and make it perfectly smooth. The
second reason why fusion is important is one which has not been sufficiently stressed.
Not infrequently the fracture lines of the os calcis are so disposed that a portion of the
bone which carries the articular surface for the posterior facet of the subastragaloid
joint is entirely separated from the bone in the fracture line.   In other words, not only
Page Forty-four is the bone fractured but that piece of bone is separated completely from its blood
supply, or in a large part from its blood supply. But in a certain proportion of cases
such a fragment is deprived of its blood supply and undergoes aseptic necrosis. It loses
the articular cartilage and, though it may become revascularized, its articular surface
has been damaged and this results in late osteoarthritis. Such cases are irreparably damaged, and if they have any late disability, it can only be overcome with fusion of the
joint. Here is another illustration of this point, showing an X-ray of one of these cases.
This is a fragment which is likely to undergo aseptic necrosis. It is such facts as these
which make more frequent use of subastragaloid fusion wise and good treatment.
In order to provide a more flexible means of treating fractures of the os calcis by
traction, we have found it necessary to apply traction in more than two directions and,
in particular, that there is need for traction in the direction of the long axis of the
foot in order to overcome the shortening that so often occurs. There is need for a pin
through the head of the metatarsals which can lengthen the foot when traction is
applied. It is of advantage that this traction be applied by an instrument which will
enable one to modify the direction of its pull within as wide limits as possible, and also
that it be applied by an instrument which will enable us to modify the force of the
traction. This traction ring which you see illustrated here has been devised for that
purpose. The man's leg is thrust through that ring there and to these hooks are
applied spreaders on Kirschner's wires through the heads of the first and fifth metatarsals.
Now, this being a circle, it is possible to shift these tractors around the circle in any
way you wish, so that the direction of the traction may be modified within wide limits.
Of course, the force can be modified by the amount of screwing up of this traction which
is applied. Now, here is an example of what can be accomplished by such tri-radiate
traction. We have here two or three sets of X-rays. Here is a very severe fracture of
the os calcis. This is the result of the application of tri-radiate traction,—much
improvement in the fracture, but this fragment is not yet perfectly reduced. One must
realize that when you put traction on that os calcis, it is resisted by the tendo-achillis.
This becomes a fulcrum against which it is difficult to tilt up the anterior end of the
bone. This is a point which I said was overlooked by Boehler in his treatment. I think
his point of view is a very good one—if I seem to point out the difficulties of the treatment it is only to emphasize the great strides made in his treatment. That problem is
a very real one and it occurs reasonably often (in about one-third of the cases), and it
is not overcome by traction of any kind or in any direction or with any force. It can,
however, be overcome if one drives in a stiff pin and uses that pin as a handle, by
means of which this fragment is drawn into position.   You can see that pin applied here.
If we are going to restore the subastragaloid joint we can rely on traction to add
much more towards that objective, but a certain proportion of cases will need something
more than traction, and most commonly they need to have that fragment tilted up at
the anterior end. Here is another example of the problem—a severe fracture of the os
calcis with gross conuninution and gross compression of the articular surface. The
articular surface is impacted into the body of the bone. This is the result obtained by
tri-radiate traction—a very nice reduction of the fracture. Now, this one was one of
the early cases in which we were carrying out our method of treatment. We obtained
a good reduction and this is the result three months later. The man went back to work
and he worked as a moulder and the results have not been perfect because he still has
pain in his subastragaloioV joint and you can see why that is. We would have done
better to have fused that joint, as he now has aseptic necrosis.
At this moment I should like to emphasize the problem of subastragaloid fusion. If
what I have told you is right, then we should take fusion as part of our treatment. If
we agree that certain cases need fusion, then the sooner we fuse them the better, in
order to save time for the patient and in order to take advantage of the early period of
osteogenesis. Now, here is a case in point—a severe fracture to the os calcis—and this
is the result obtained by traction. It is very easy to apply great force on this tractor.
Actually, the amount of force needed is not very much—there is a tendency to over-pull.
Page Forty-five At this moment I should like to discuss the aspect of fusion of this subastragaloid
joint as applied to the particular problem that we have in mind. All of us have been
faced with the necessity of fusion because of disability which follows fractures of the
os calcis and most of us have approached the joint from the lateral side of the foot.
Now, such lateral exposures are difficult. Subastragaloid fusion in a joint which has not
been damaged is a nice bit of technique and not done easily unless it is done in a very
precise fashion, but when the joint has been severely damaged then the exposure of the
joint is extremely difficult and cannot be accomplished without at the same time exposing the mid-tarsal joint, and that necessitates fusion of the mid-tarsal joint.
Some time ago Dr. Gallie devised an operation for mid fusions of the subastragaloid
joint which overcame some of these problems, the chief point being an encroachment
from behind and the insertion of bone grafts between the os calcis and the astragalus.
I may say that it is one of the simplest of procedures and is effective. When you think
a fracture of the os calcis is going to give late trouble and you think it should be fused,
then do it early for the best bony union. Having decided that the fracture of the os
calcis is of such a nature that late trouble is going to occur, there is no reason at all why
fusion should not at once be proceeded with, even though the plaster is still on, because
it is possible to do the operation from behind through a window in the cast and that is
what we have been doing quite satisfactorily.
This drawing represents a fracture of the os calcis which has been reduced by tri-
radiate traction. Ten days after reduction a window was cut in the plaster and a fusion
was performed. It is a simple exposure and through that exposure a rectangular tunnel
is cut in the subastragaloid joint. That is quite easy to do. This tunnel is cut with a
chisel. This slide illustrates the procedure. A double graft is then thrust into this
tunnel and we have the joint bridged by these two grafts. This is the type of fracture
in which we think this aspect of treatment should be considered—a very gross comminution of the fragments. This is the result obtained by traction. You can readily
see that there is still tremendous crushing and cornrninution of the central portions of
the bone. It was our judgment that it was the best reduction that we could obtain so
ten days afterwards an operation was preformed and a graft was placed in the subastragaloid joint. This is a photograph of the apparatus in use. We use heavy Kirsch-
ner wire instead of Steinman pins. This is another picture of the same patient, showing
the tri-radiate traction apparatus. Having reduced the fracture to our satisfaction and
having checked it by X-ray, a plaster is applied incorporating the steel wire and the
pins.   Here is another case in which the tractor has been applied.
Now, this picture illustrates a number of problems. Here is a moderately severe
fracture of the os calcis with moderate compression of the posterior half of the subastragaloid joint. Here are a series of X-rays which illustrate the steps in the reduction
of the fracture. Here you see the effect of traction alone and it has lengthened the
bone and it has improved the position and restored the critical angle but it has not
reduced that articular portion of the os calcis adequately. An attempt was made to do
that with a heavy Kirschner wire but it was not strong enough, so a Steinman pin was
put in place and this improved the condition considerably though there is still room for
improvement.
Now, here are a number of X-rays of patients, illustrating a number of the problems.
Here are the X-rays of _ man who had a double fracture to the os calcis and we treated
both his fractures in this manner. There was no operative fusion of his joint as his
trauma was so great. This series shows a moderately severe fracture. This shows the
result of reduction by traction.
In conclusion, I would say that it is well to regard fractures of the os calcis as a
major problem in fracture surgery. It is necessary to appreciate that fractures of the
os calcis vary greatly from one to the other. Therefore, we must individualize each
problem. We must study the fracture and the X-ray and decide what is necessary in
this particular case. We must make up our minds at the beginning whether a fracture
of the os calcis presents a major problem or whether it is a simple problem in fracture
Page Forty-six treatment. If it is a major problem then we must find the means of dealing with it
adequately right away at the beginning. The procedures which will do most to give a
good result are:
(1) Traction, especially if it is tri-radiate traction and especially if it is sufficiently
flexible that its direction can be changed and its force can be changed. When traction
is used we should have some means of checking the result by X-rays during the procedure.
(2) We should appreciate that some other measure than traction may be necessary
in certain cases to restore the bone to something like its normal shape, and this is our
objective. We should appreciate that in a considerable proportion of our cases, no matter how skillfully we handle the fracture, there will be gross damage to the subastragaloid
joint and late disability will be inevitable. These should be treated with subastragaloid
fusion and the sooner the fusion is done the sooner the man will be back at work.
Posterior fusion has given the most satisfactory results. The freedom of the mid-tarsal
joint to move has not proved a disability when the subastragaloid joint is fused. On the
contrary, it has been an asset.
DR. A. W. BAGNALL
Obiit Nov. 22, 1944     |
The medical profession of Vancouver has sustained many blows lately by
the loss of some of its older and most valued members—and the loss of Dr.
Wallace Bagnall is by no means the least of these. He had been in practice in
Vancouver for many years and had reached the top of his profession, as an
internist of rare skill and ripened judgment, whose work was regarded as being
of the best. His integrity of character and his sincerity of mind, gave to his
opinions a soundness and maturity that made him a valued consultant to his
colleagues, and a practitioner of assured worth, to the public at large.
Bagnall was always a student, and had the critical faculty of mind. This
is a very valuable quality in the man of medicine, and not as commonly possessed as it should be. His bump of credulity was poorly developed, and he
examined each new thing with critical care. He was not easily made enthusiastic about new things—and in all his doings, not merely professional, he preserved an open mind, and had to be shown. But when he did become interested
in a subject he explored it exhaustively—and mastered it thoroughly. He was
especially interested in Rheumatism and Arthritis, and made himself one of the
foremost authorities on these subjects in Canada. His work on the gold
therapy of Arthritis was of the pioneer order—and one remembers a most
complete report made by him on the subject many years ago. Even here,
however, enthusiastic as he was on the subject, he did not lose his head or
become fanatic at all, and rather offended some of the ultra-enthusiasts by his
conservative attitude towards the matter.
Bagnall was a quiet, almost austere man, who made no fuss and did not
apparently go out of his way to assert himself—but he was very warmly
respected and liked by all who knew him. It is very pleasant to reflect on the
occasion at the last Medical Dinner when the Degree of Prince of Good Fellows,
the Vancouver Medical Association's cachet of worth and true fellowship, was
conferred on Wallace Bagnall. It warmed the hearts of all his legion of friends,
and we rejoice that he knew, before he left us, that we loved him, as well as
respecting and liking him.
The Vancouver Medical Association owes a special debt to Dr. Bagnall.
He served on the Library Committee for many years, and no member of that
Page Forty-seven *
Conunittee ever gave more generously and freely of his time and energy.    It
is not too much to say that a great deal of the present excellence and efficiency
of the Library is due to the work that he did year after year, and to his constructive interest and mature experience.    His place will be hard to fill.
We offer to his family our sincerest sympathy in their loss.
DR. M. W. THOMAS
Obiit Nov. 11, 1944
The grievous and untimely death by drowning of Dr. Morris Thomas,
Executive Secretary of the College of Physicians and Surgeons of B. C. and the
B. C. Medical Association, brought a profound sense of shock to every medical
man in British Columbia, and to scores outside this province, who had come to
know and respect him as one of the leaders in the medical organization of
Canada. The shock was followed by a deep sense of personal loss, as of a dear
friend, whose passing has left a gap in one's more intimate life.
Thomas had, more than most men, a genius for friendship and a great
affection for his friends. He knew men personally—he took a keen interest in
all that befell them—in their family relationships and their professional doings
—he knew what their hobbies and recreations were—he rejoiced with them in
their happier moments—and sorrowed with them in times of trouble. One
felt that he knew intimately every man in the Province, and the further the
man lived from the centres of population, the more anxious was our Secretary
to do all he could for him. He was always working for the men in practice.
Perhaps this was his duty—but Thomas brought to this duty a devotion and
a loyalty that made him the friend, as well as the willing servant, of all that
it was his duty to serve.
He was a good fighter, too—and the medical profession owes much to his
courageous battling for their interests. Many a man in B. C. will testify to
the help and support that he received from our Secretary, in his dealings with
employers of labour, and groups of employees seeking medical service. The
Medical Services Association, so successfully operating in our midst, owes an
uncountable debt to his work and indomitable support—and his refusal to
allow inferior schemes to compete unjustly and unfairly with it.
Organized medicine in B. C. can never repay its debt to Dr. Thomas. He was
an almost ideal man for the work he carried on for so many years—and it is
very hard to see how he can be replaced. It may be that no man is indispensable: that even the loss of a Moses need not mean irreparable disaster—that the
thing for us to do is, as Joshua had to do, to get up and go on—but we have
lost a very valuable and badly-needed guide, counsellor and friend—and it will
be long before we shall see his like again.
We feel that we speak for every medical man in British Columbia when we
extend to Mrs. Thomas and his family our deepest sympathy in their bereavement. ^
Page Forty-eight «
V
ancouver
G
enera
Hospita
THE DIAGNOSIS OF A NEUROSIS
Geo. A. Davidson, M.D.
Presented at the North Pacific Society of Internal Medicine, Vancouver, B.C., September 16, 1944.
More and more it is being stressed that the diagnosis of the Neuroses is ont made
by excluding organic disease. A neurosis is a definite disorder and the diagnosis calls for
certain findings as much as the diagnosis of pneumonia, hyperthyroidism or any such diseases. It is because it is felt that so many neglect this basic fact that it is thought wise
to discuss the question of the diagnosis. We are told that 30 to 50% of the discharges
and rejects from our armies are due to mental, emotional and educational faults. It
takes but a short time in medical practice to make one realize that he has had little
training to make him feel at ease in dealing with this type of disorder if he comes from
an average medical school. While this paper will contain little that is new, it is hoped
that it will bring those interested in Internal Medicine a better understanding of what
the term Neurosis actually means.
A few months ago a 42-year-old male was referred because of complaints that were
suggestive more of a neurosis than of organic disease, e.g., he had spells of feeling faint,
his stomach was unsettled and his heart palpitated. He had been off work for one year
but had been undergoing examinations for two months prior to that. He had been in
one hospital, had seen two physicians and had gone "through" three clinics. He had
had X-rays taken of his chest, stomach and colon. He had had three different electrocardiograms and at least three basal metabolic ratings, and had had various blood and
other tests. This work had cost him more than $300 and he had lost about $3500
because of unearned wages (salary $85 per week). With the exception of one medical
man all eventually reached the conclusion that it was "nothing but nerves" and he was
told to "go ahead and don't worry." He stated that one well-known clinic had told
him that there was nothing that a physician could do. My suggestion is that had a
more careful history been taken with a view to understanding the man rather than his
individual organs, he would have been saved much worry, expense, and much of the
time spent by the various physicians would have been saved. Another point of great
importance is that during the fourteen months on treatment he had developed many bad
habits of thought, and had reached a point where it was much more difficult to deal with
him than it would have been at first. The easiest time to deal with these cases is when
the symptoms are new, when the patient must be studied carefully and given an understanding of the meaning of his symptoms.    His problem will be returned to later.
Who Develop Neuroses?
I.    The Insecure Background.
In studying an individual with symptoms the logical method is to deal with the
patient as a whole and not to think only in terms of how the heart, stomach and other
organs are behaving. The whole life situation must be seen as clearly as possible so that
the various influences that have played on this individual from his childhood can be
properly evaluated. It is suggested that the most necessary single point for the diagnosis
of a neurosis is to decide whether or not the individual had felt secure in his childhood.
The child deserves security and the child who is secure is most likely to become a stable
and confident adult. It has been recognized that home situations have much to do with
the development of neurotic states. Death of a parent or divorce of parents are tragedies
that reach far into the future of the child's life. This is probably largely due to the
fact that the child feels so often that he is left in an insecure position.   Too often when
Page Forty-nine the father dies the mother is left with an inadequate income and in addition to having
to worry over the bodily needs there is no longer the partner to help absorb and modify
the emotional situations that develop. Too frequently the mother pours out her grief
on the eldest child so that he must face problems of both economic and emotional
natures that he is not yet ready to face. Instead of continuing his life of play and
gradually accepting adult responsibilities these are suddenly thrust on him so that he
develops a habit of reacting in an anxious way to difficult situations—a habit that often
persists with him throughout life.
Strife in the home will also produce a feeling of insecurity and uncertainty in the
child and cause him anxieties too early in life.
Another point that should be stressed is the effect of the over-anxious, over-solicitous
mother on the child. There is too much fear expressed that the child will catch a cold,
get his feet wet or meet with an accident so that often the child looks upon life as a
dangerous business and full of hazards rather than taking new experiences in his stride
and with ease.
In a group of pension cases suffering from so-called Neurocirculatory Asthenia there
were nine cases that had been under observation for 15 years or more. Six of the nine
patients had lost one parent before he was 15 years of age, ono had lived in an atmosphere of over-protection and one had a father who had been an invalid for years. In
this same group where figures were available for 18 of the group, nine who developed
the disorder were first children although the group as a whole averaged seven children
per family.
Those things in a home situation that make the child feel insecure and afraid have
been discussed at some length as it is felt that the neuroses have their setting well back
in the life of the individual.
II. The Necessity for Adjustments in Life.
With this picture in mind the adjustments that the individual has to make may be
considered. Kraines1 has put this nicely when he says: "If one disregards all hair-splitting phrases and obscure terminology, it may be generally agreed that all psychologic
reactions are built up, pyramided on two fundamental drives—the drive for self-preservation (ego-maintenance) and the drive for race preservation (predominantly sexual).
In other words, man seeks security and satisfactions." Note the term "security"! Put
otherwise, if one is happy and contented in his efforts at self-preservation, be they
satisfaction in his school work, his office or labours, and if one is satisfied with his relationship to the opposite sex, be it puppy love or a satisfactory marital adjustment, "all's
right with the world." Probably this might be extended a little to include his relationship to people generally, i.e., the making of a satisfactory social adjustment.
If, then, the initial complaints are of a nature that suggest emotional trouble rather
than organic disease, it is felt that it is the duty of physicians to enquire into these
adjustments. Physicians often are timid about asking such personal questions and yet
the patient is usually anxious to discuss them and unburden himself.
III. The Physical Findings Expected.
Broadly speaking, psychoneurotic symptoms and signs may be divided into two
groups, (a) those expressed by tension, and (b) those expressed by conversion. In the
tension states one sees the type of case produced by autonomic overactivity, i.e., definite
physiological activity is produced.
According to Fulton2, stimulation of the hypothalamus indicates that the posterior
and lateral hypothalamic nuclei are concerned primarily with the sympathetic outflow,
the following responses being seen: (a) Cardiac acceleration, (b) elevation of the blood
pressure, (c) dilatation of the pupil, (d) retraction of the nictitating membrane, (e)
piloerection, and (f) inhibition of the gut. He says further that these hypothalamic
nuclei also have connections with the cerebral cortex, generally through secondary
neurons via the zona incerta, septum pellucidum and mamillo-thalamic tract.
Page Fifty Bodily changes as a result of emotional reactions have long been recognized although
the cortico-hypothalamic connections have only recently been worked out, and these
not entirely as yet. The names of Pavlov3, Cannon4, Wolf and Wolff5 at once bring
to mind some of the important work that has been done and more recently have the
roles of emotion been stressed in such diseases as peptic ulcer and hyperthyroidism. If
the symptoms associated with sympathetic stimulation are kept in mind many of the
symptoms and signs seen in the neurosis are evident, e.g., dilated pupils, increased heart
rate, increased systolic pressure, disturbances in the secretion and motility of the
stomach and bowel, urinary disturbances, disturbances of sweating, etc. The neurosurgeons with their attacks on the frontal areas have clearly demonstrated that definite
change "can be produced in the personality with a decrease in the general tension.
Keeping in mind the type of background expected in the neuroses, the difficulties in
adjusting to certain life situations and the physiological changes resulting from cortical-
hypothalamic disturbances, the history of the man who was off work for over a year
because of his so-called "nervous state" may be reviewed.
When the patient was 12 years of age his father died as a result of an accident. His
mother had quite a struggle to raise the family after her husband's death and she was
regarded as nervous, suffered with certain "spells" and was said to have overworked.
The eldest brother did not accept much responsibility for the family although he was
20 years of age when the father died. The next two children were girls. Each had
suffered from breakdowns and appear to have been badly adjusted. The patient was
quite aware of all the family troubles. From the age of 12 years he worked after school
and turned his earnings over to his mother. He left school entirely at 13 years of age
and has always been sensitive because of his lack of formal education. Although he
changed positions fairly frequently he did very well until, due to the war, he was forced
to change his occupation. He started work in a shipyard, where the pressure was quite
sustained. At the same time he was doing a certain amount of gambling at cards and
at horse "and dog races. The excitement of this probably gave him symptoms referable
to his autonomic nervous system. He did well in the shipyards but did not like the
responsibility, had some fear of his boss and got the idea that this man might welcome
an opportunity to show his authority. He began to have spells in which he would feel
faint, his stomach felt unsettled, his heart palpitated and he was constipated. He was
advised to stay off work to see how he felt and from that time on did not return to the
shipyards and actually did not get back to any kind of work until about July 1, 1944,
that is, more than one year from the time he stopped work.
Physically he showed fine tremors to the fingers, brisk jerks, moderately enlarged
tonsils, a coated tongue, a pulse rate that varied between 88-120 and a blood pressure of
140/88.    The hands were decidedly moist and cool.
This is regarded as a fairly typical neurosis (tension state) because of the (a) insecure childhood, (b) the difficulty in adjusting to the change of work with the increased
pressure, and (c)  because of some of the physical signs which are common in neurosis.
I am particularly interested in your reactions as to the amount of work that should
be done in ruling out organic disease and especially in the laboratory work. In such a
case as has been described, would we be justified in reaching the diagnosis of a neurosis
without the extensive laboratory work being done? From the history, would we not be
reasonably justified in omitting much of this work? Interestingly enough, it was at
one time suggested that the man suffered from hyperthyroidism, and yet when he visited
a man who confines himself largely to the diagnosis and treatment of diseases of the
thyroid gland this man did not think that it was necessary to do a basal metabolic
estimation—a test, incidentally, in which I believe we place altogether too much faith,
as in about 98% of tests it is within our accepted range of normal, and that is a wide
range.
Some internists believe that any man who presents himself with complaints referable
to the stomach should have a series of stomach and bowel pictures. Should these be
insisted upon, and will an injustice be done to a large number of our patients if we do
Page Fifty-one not demand it? True it is that the trend today appears to be to believe that emotional
instability is a forerunner of peptic ulcer. Many men feel that they are running too
great a chance of missing structural change and yet this is doubted.
I have reached the conclusion, and it is felt that you will agree, that many patients
are not convinced by negative reports and they believe that the physician must be overlooking something or that his disorder is beyond the knowledge of medical men. How
often the patient will insist that we do not understand, and whether he says so or not
the fact that he drifts from one physician to another is proof that he has not entire
confidence in our findings and reports.
Many physicians believe that a lot of tests impress the patient and make him feel
more confident in his physician. This is doubtful. It is felt that care should be taken
in obtaining the history with an attempt to understand the man and his problems, and
a physical examination should be done to confirm or make you doubt your diagnosis.
If the other course is followed, how frequently do we hear patients say, "Well, Doctor,
if there is nothing wrong with me but an emotional condition, why did Dr. X make
all those tests on me and put me to so much expense? Surely he must have felt differently."
This, of course, is about the same as saying that your patient feels justified in doubting your diagnosis when Dr. X, who undoubtedly was a good man, was not certain of
the condition. In other words, he feels that the doctors are in doubt and it is felt that
this would not occur if the first man who saw the case treated it with understanding
and confidence.
While it is not my intention to discuss the treatment of the neurosis, it is felt that it
is our duty to give the patient some understanding of the physiological responses of the
body to emotional factors.
It is agreed that not all cases of neuroses are as typical as the one described, and yet
he was examined and re-examined and still left in doubt and without relief.
Briefly, my contention is this: (a) Having in mind the structure of the neurosis
and (b) being familiar with the "ring" of the symptoms described, our attentions should
be directed towards a better understanding of the man and his problems and less attention should be paid to the study of his individual organs..
It is realized that these suggestions will be received with antagonism and criticism
by many of the organically-rninded men present, and yet it is felt that as a group we
are open to criticism for the way in which we deal with this group of patients and for
the way in which we go through with our rituals and end up by telling the man to
"Forget it.    It's nothing but nerves."
Summary
1. The diagnosis of a neurosis is not made by exclusion but this disorder has a definite
symptom complex; a definite background of insecurity, a history of difficulty in
adjusting to some problems and certain physical findings indicative of (a) tension or
(b)  conversion.
2. The physiological effects of emotion are discussed especially as they affect the
cortico-hypothalamic-autonomic system.
3. It is argued that much unnecessary investigation and laboratory work is done on this
group of patients without value being received.
4. And finally in having reached our conclusion that the condition is a neurosis it is
felt that we owe the patient an explanation as to why he develops his symptoms and
why they persist, rather than leaving him with a diagnosis of "just nerves."
BIBLIOGRAPHY:
1. Kraines, S. H., The Therapy of the Neuroses and Psychoses, Lea & Febiger, 1943.
2. Fulton, J. F., Physiology of the Nervous System, Oxford University Press, 1943.
3. Pavlov, I. P., Conditioned Reflexes and Psychiatry, trans, by w". H. Gantt, New York. Internatoinal
Publishing Co., 1941.
4. Cannon, "W. B., Bodily Changes in Pain, Hunger, Fear and Rage, 2nd ed., D. Appleton & Co., 1929.
5. wolf, S., and Wolff, H. G., Evidence on the Genesis of Peptic Ulcer in Man. J. Amer. Med. Ass.,
1942, 670-675.
Page Fifty-tw6 EMOTIONAL PROBLEMS OF DEMOBILIZATION
Maj.-Gen. Chisholm
Read before the B. C. Medical Association, September, 1944
The process of changing oneself from a soldier to a civilian is in very many cases
at least just as difficult psychologically as the change from civilian to soldier. In a
typically successful soldier the total environment has been oriented towards successfully
fighting the enemy for a period of anything from one to five years, or more. Every
pressure directly influencing the soldier has been formulated and exerted in this direction. His whole value is judged by his efficiency as a fighter or in giving support to
other fighters. The whole object of his existence and the focus of all endeavour about
him is killing. Effective and wholesale killing has been for years given precedence as
the highest moral value and the most admirable of all virtues.
The soldier has become accustomed to living in a very close knit community which
in relation to its main preoccupation is completely reliable and dependable. Its reactions
in relation to any important question are completely predictable. All its moral values
are quite clear and all friends and enemies are known.
There is little real psychological preparation for the cessation of hostilities during
the closing weeks of any campaign. Emotional tension runs very high; there is great
preoccupation with the events of the moment which are almost invariably new and
strange and exciting. Soldiers generally do not allow themselves to count too surely on
surviving a war, at least* without severe crippling. In long continued warfare it tends
to become evident to soldiers that only major wounds leaving permanent crippling are
likely to ensure their survival. Even repeated minor wounds keep men away from fighting only short periods and there is a high degree of mathematical likelihood of the soldier being killed if he does not receive major wounds. Very many soldiers, showing a
degree of superstition which because of its almost universal presence in our civilization
must be regarded as normal, feel that it is dangerous to count on survival, that this is
in some way a defiance of some Power which may be annoyed at such presumption. It
is true that soldiers generally indulge in much fantasy about living conditions "after the
war," but these are kept clearly in the realm of fantasy and are heavily discounted as a
precautionary measure.
The cessation of hostilities is experienced as a major emotional shock by soldiers generally. There is a very extensive loss of orientation, a feeling of being lost and bewildered, a groping, turning towards the things of civilian life and all its very different
values. During this period, soldiers tend to be highly labile in mood, unstable and unpredictable. Typically they can hardly be induced to concentrate on anything for very
long at a time. The sudden release from the years-old fear of imminent death with the
release of all the consequent tensions, leaves soldiers disorganized and uncertain. These
states may be expressed in quarrelling, defiance, drunkenness, even rioting and insurrec-"
tion. Aggressive urges which have been carefully nurtured and developed over a period
of years are supposed to disappear overnight, leaving a peaceful civilian with no such
pressures and consequently no need of outlet. The soldier is expected overnight to give
up what in very many cases at least is a consuming hatred, and in all cases the object of
aggressive antagonism and to become protective and friendly towards the very people
whom he has been hating for years. With the memory of all this, of his friends or rela-
times who have been killed or maimed or even tortured by the enemy, fresh in his
experience and kept alive as a spur to his aggressions, this changeover in attitude may
be very difficult indeed. It may be successful on the surface but at the expense of extensive repressions and conflict within himself.
The cessation of hostilities, in the mind of a soldier, renders his continuing as a
soldier completely pointless. He has lost his reason for being a soldier and the period
during which he must be kept in the Army with no fighting to do either in the present
or future feels to him unreasonable and persecutory. All these considerations point to
the difficulty in the early stages of the period after the cessation of hostilities.
In addition to the disturbed relationship with his immediate environment, he must
undergo a reorientation towards civilian life, employment, family and friends.   In very
Page Fifty-three many cases the separation between husband and wife has been far more than geographical. Each has been developing along different lines. This is not to indicate that
there will necessarily be any loss of love between husband and wife. The tendency is
rather for each to idealize the other and to maintain a picture of the other which may
be too difficult to live up to. On the other hand, suspicion about sexual fidelity is very
common and may cause much trouble, whether justified or not. The relationship of
the returning father with his children may also be difficult. The ease of the establishment of such a relationship depends largely on the truth of the picture which the
mother has presented to the children, of the father. If she has over a period of several
years painted a picutre which is rather her idealization of him than himself as he is, the
children and the father will inevitably be in difficulties when he returns. There is a
tendency in many women to use the absent father as authoritative backing for all their
own ideas about desirable behaviour in children and to represent the father as having
attitudes which in fact are their own and not his at all. When the father returns and
persists in talking and behaving as himself rather than as the idealized picture, the
children may become bewildered, and the mother resentful of her husband's letting down
her ideal of him.
Commonly too the wife has for some years been relatively independent, with the
family's money in her own purse to be spent entirely as she sees fit. This circumstance
has produced in most women a much greater sense of financial responsibility. A few
have become, of course, more irresponsible. The return of the husband will in almost
every case affect the financial independence of the wife, so that the spending of family
resources becomes at best a matter for consultation between husband and wife, and at
worst an absolute dominance by the husband or by the wife in this field. Either of
these latter situations will complicate the re-establishment of the family and the development of the children.
A further possible complication is the greatly enhanced group value of many women,
who have devoted themselves to canteens, Red Cross, and many other services, including
war work of all kinds, whether in factories or in committees. It will require a major
readjustment for these women if it becomes necessary for them in effect to retire to
their homes and become again "only", housewives. It is to be hoped that at least a
large part of this enormous amount of potentially valuable effort can be redirected into
channels which will continue to be useful during peacetime.
In relation to civilian employment, there is also a major job of reorientation to be
done. There are large numbers of men in the Armed Forces who have never had any
really stable civilian employment. Many thousands have come directly out of schools
and colleges. The transition from a closely knit group whose major virtues have been
bravery, self-sacrifice and value to the group, to a society whose values are most
usually measured in monetary terms, may be very difficult indeed. Transition from the
long continued state of devotion to one's friends and to a cause, to the self-seeking
attitude which is so common in civilian life, has always been confusing and difficult for
demobilizing soldiers. The emotional need of the soldier after years of conditioning, is
not just for monetary reward but for emotional status even more importantly. He
needs more to feel valuable and important than he does to feel wealthy. This typical
need of the returned soldier to feel important to the group, if appreciated and used,
can be of the greatest importance to the future of any country. If it is not satisfied
the inevitable tendency will be for the returned soldier to segregate himself with those
of his kind from the mass of the people and to insist on his rights and privileges.
The detailing of all these potential difficulties may indicate a pessimistic atttude
about the rehabilitation of the soldier. Actually all these difficulties can be avoided or
overcome by intelligent understanding and determination. It is, however, very important
that there should not be a general attitude about rehabilitation like the Victorian novelist's idea of marriage, "And then they were married and lived happily ever after." "And
then he returned from the wars and they lived happily ever after" can be true but will
be so only if the inherent problems in this major adjustment are tackled with wisdom
Page Fifty-four and forbearance. Much can be done to increase the understanding of both soldier and
civilian in this field so that it should be possible to develop general understanding of
the problems involved, and a much greater degree of tolerance and helpfulness on the
part of both.
In the Army it is proposed to prepare soldiers for demobilization by courses of lectures and discussions in small groups in an attempt to make the transition to civilian fife
less uncomfortable and, as so often happens, disillusioning. The newspapers, magazines
and the radio can do much along the same lines for civilians. It should never be taken
for granted that all the adjustment has to be done by the returning soldier. Civilians
may well find certain aspects of the philosophy of the good soldier which could with
value be incorporated into their own thinking and feeling patterns.
NEWS    AND    NOTES
We regret to record the passing of: Dr. M. W. Thomas, Executive Secretary of the
College of Physicians and Surgeons, on November 11th; Dr. A. W. Bagnall, of Vancouver, on November 22nd; Dr. G. A. McCurdy, of Victoria, on November 21st; Dr.
Wm. Buchanan, of Peachland, on December 5 th, and Dr. A. McK. Stewart of Haney.
Of interest to the profession is the marriage of Major A. Maxwell Evans, R.C.A.
M.C., Radiologist with No. 1 Canadian General Hospital in Italy, to Miss Eleanor Mionr,
Red Cross Welfare Officer of Windsor, Ont.   The wedding took place in Italy.
Congratulations on the birth of daughters are being received by Dr. and Mrs. Neil
A. Stewart of Vancouver, and Surg.-Lieut. F. E. Kinsey and Mrs. Kinsey.
Sons were born to Dr. and Mrs. H. Dumont of Vancouver, Dr. and Mrs. H. Emanuele
of Penticton, and Dr. and Mrs. John Piters of Vancouver.
Lieut.-Col. A. L. Cornish, Victoria; Lieut.-Col. S. A. Wallace, formerly of Kamloops, and Major J. E. Walker of Vancouver are on the staff of the newly commissioned
hospital ship Letitia, which has just completed her maiden voyage.
S/Ldr. J. L. Parnell, formerly of Vancouver, is now with the R.C.A.F. headquarters
in the Middle East.
Capt. W. S. Huckvale, R.C.A.M.C.-, who was wounded overseas, is back in Vancouver.
The following are the officers of the Fraser Valley Medical Association for the year
1944-45: President, Dr. H. H. MacKenzie; Vice-President, Dr. G. H. Manchester;
Secretary-Treasurer, Dr. J. G. Robertson. The representative on the Board of Directors
of the British Columbia Medical Association is Dr. Bruce Cannon.
The Board of Directors of the British Columbia Medical Association held a meeting
on November 29th. Those members present from out of town included: Doctors D. M.
Baillie and P. A. C. Cousland of Victoria; Dr. F. M. Auld, Nelson; Dr. C. H. Hankinson,
Prince Rupert; Drs. A. H. Meneely and E. D. Emery of Nanaimo, and Dr. G. S. Purvis,
New Westminster.
Doctors F. M. Bryant and Thomas McPherson of Victoria; F. M. Auld, Nelson;
G. S. Purvis of New Westminster, and E. J. Lyon of Prince George, attended the meeting of the Council of the College of Physicians and Surgeons held in Vancouver on
November 30th.
Page Fifty-five NOTICE
It has been brought to our attention that some medical men fail to write
prescriptions for narcotics in INK and also fail to DATE prescriptions as
required by law. Druggists may refuse at any time to fill prescriptions not
written in ink or not dated.    Medical men must adhere to the rules.
A. J. McLachlan,
Registrar.
Capt. W. H. S. Stockton, R.C.A.M.C, has returned to Vancouver. Capt. Stockton
was injured in an automobile accident in Italy.
Flight-Lieut. G. A. Lawson, R.CA.F., who has returned to civilian life, is at present
in the East taking a post-graduate course.
Doctors C W. Duck, R. A. Hunter, T. M. Jojnes and R. B. Robertson of Victoria
were recently on short hunting trips on the mainland.
Dr. W. E. Baker has opened an office in Victoria, confining his work to Ear, Nose
and Throat.   Dr. Baker served with the R.C.A.M.C.
Flight-Lieut. H. B. McGregor, R.CA.F., has returned to civilian life, and is resuming
practice in Penticton.
Dr. F. R. G. Langston and his wife, Dr. Kathleen Woods Langston, have returned to
the Province, after several years spent in England.
Capt. P. S. Tennant, R.CA.M.C, has returned to civilian life, and is practising at
Kamloops. 	
EAST KOOTENAY MEDICAL ASSOCIATION
On October 29th, a meeting of the East Kootenay Medical Society was held in
Cranbrook.
During the afternoon, in the St. Eugene Hospital School of Nursing, the scientific
sessions were heard. Dr. G. O. Matthews gave a talk on "Some Paediatric Conditions
and their Treatment" and Dr. Murray Meekison spoke on "Common Problems met
with in dealing with Fractures." These papers were well received and thoroughly appreciated.
During the short intermission between papers the Sisters of St. Eugene Hospital
provided refreshments.
In the evening a dinner was held in the Cranbrook Hotel. Following dinner, Dr.
G. O. Matthews, President of the British Columbia Medical Association, addressed the
members. Among other matters he discussed the formation of a Faculty of Medicine
in B. C
Dr. M. W. Thomas, Executive Secretary of the College of Physicians and Surgeons,
spoke briefly on medical economics, and on the subject of a revised schedule of fees.
Dr. F. M. Auld of Nelson, member of the Council of the College for the Kootenays,
gave a short address on the activities of the Qmncil.
Dr. H. H. Milburn, President of the College of Physicians and Surgeons, described
various health plans, and brought up the subject of a Medical Faculty.
Dr. F. W. Green spoke briefly on medical practice in East Kootenay. As M.L.A. for
the District he would be pleased to place before the Provincial Legislature any subjects
which the College of Physicians and Surgeons wished to bring to its attention.
After a short address by Dr. W. O. Green, in which he thanked, the visiting doctors
for devoting so much time in attending the meeting in Cranbrook, the officers for the
coming year were chosen:
Page Fifty-six
■ President: Dr. J. Vernon Murray, Creston; Vice-President: Dr. T. J. Sullivan, Cranbrook; Secretary: Dr. W. O. Green, Cranbrook.
Those members present at the meeting included: Drs. G. O. Matthews, D. M.
Meekison, H. H. Milburn, M. W. Thomas, from Vancouver; Dr. F. M. Auld, Nelson;
Dr. G. W. Leroux, Fernie; Dr. J. Vernon Murray, Creston; Dr. A. E. Kydd, Michel;
Dr. J. M. Tedford, Kimberley; Drs. F. W. Green, W. O. Green and T. J. Sullivan,
Cranbrook.
DISTRICT No. 4 MEDICAL ASSOCIATION
ANNUAL MEETING
The annual meeting of District No. 4 Medical Association was held in Kelowna on
Thursday, October 26th, at the Royal Anne Hotel. Dr. L. A. C. Panton, President,
presided over the sessions, and was ably assisted by Dr. W. F. Anderson, Secretary.
Dr. Gordon O. Matthews and Dr. D. Murray Meekison, both of Vancouver, gave
scientific papers, the former dealing with paediatrics and the latter orthopaedic surgery.
The election placed the following in office:
President: Dr. R. W. Irving, Kamloops; Vice-President: Dr. J. R. Parmley, Penticton; Secretary-Treasurer: Dr. C J. M. Willoughby, Kamloops; Representative on the
Board of Directors of the British Columbia Medical Association: Dr. R. W. Irving.
It was decided that the next annual meeting would be held in Kamloops.
Those present at the meeting included: Dr. G. O. Matthews, Vancouver, President
of the British Columbia Medical Association; Dr. H. H. Milburn, Vancouver, President
of the College of Physicians and Surgeons of B. C; Dr. M. W. Thomas, Executive Secretary of the College of Physicians and Surgeons; Dr. E. J. Lyon, Prince George, District
Representative on the Council of the College of Physicians and Surgeons; Dr. D. Murray
Meekison, Vancouver; Drs. J. S. Burris, R. W. Irving, H. F. P. Grafton of Kamloops;
Dr. A. F. Gillis, Merritt; Drs. R. H. Irish, E. A. Gee, W. G. Trapp Tranquille; Dr. W.
A. Drununond, Salmon Arm; Dr. J. H. Kope, Enderby; Dr. R. Haugen, Armstrong;
Drs. J. E. Harvey, A. J. Wright, F. E. Pettman, H. I. Campbell-Brown, J. A. Taylor,
Vernon; Dr. W. H. B. Munn, Flight-Lieut. A. W. Vanderburgh, Summerland; Drs.
J. R. Parmley, L. F. Brogden, Penticton; Dr. G. W. Cope, Oliver; Drs. W. J. Knox,
B. de F. Boyce, L. A. C Panton, W. F. Anderson, A. S. Underhill, D. M. Black, J. A.
Urquhart, G. McL. Wilson, J. S. Henderson and D. B. Avison of Kelowna.
WEST KOOTENAY MEDICAL ASSOCIATION
ANNUAL MEETING
The West Kootenay Medical Association held its annual meeting in Rossland on
Saturday, October 28 th, at the Rossland Hospital. The meeting was under the able
chairmanship of Dr. E. E. Topliff, President.
The team from Vancouver included Dr. Gordon O. Matthews, Paediatrician, and
President of the British Columbia Medical Association; Dr. D. Murray Meekison, Orthopaedist; Dr. H, H. Milburn, President of the College of Physicians and Surgeons, and
Dr. M. W. Thomas, Executive Secretary of the College. Dr. Matthews and Dr. Meekison contributed papers of a scientific nature to the meeting, while Dr. Milburn and
Dr. Thomas addressed the gathering at the banquet which followed.
The following were elected to office:
Honorary President: Dr. G. M. Kingston, Grand Forks; President, Dr. G. R. Barrett,
Nelson; Vice-President: Dr. Arnold Francis, New Denver; Secretary-Treasurer: Dr.
Wilfrid Laishley, Nelson; Representative on the Board of Directors of the British Columbia Medical Association: Dr. G. R. Barrett.
The meeting was well attended and among those present were: Drs. E. E. Topliff,
and L. B. Wrinch, Rossland; Drs. W. A. Coghlin, M. R. Basted, D. J. M. Crawford,
J. S. Daly, E. S. Hoare, M. E. Krause, Wm. Leonard of Trail; W. H. Ormond, Sloe an;
Dr. Arnold Francis, New Denver; Drs. F. M. Auld, W. Laishley, N. E. Morrison, G. R.
Barrett, R. B. Brummitt of Nelson; Captain Gordon, and Drs. G. O. Matthews, D. M.
Meekison, H. H. Milburn and M. W. Thomas, Vancouver.
Page Fifty-seven REMUNERATION TO PRIVATE PHYSICIANS FOR
INDIGENT V.D. CASES
The Division of Venereal Disease Control of the Provincial Board of Health is
pleased to announce that as from December 1, 1944, there will be an increase in the
rate of payment to private physicians for treating venereal disease cases who are unable
to make any payment for such treatment. Payment is made only to private physicians
practising in areas where no clinic is operated by the Division. The usual reasonable fee
charged will be paid for the initial examination, including smear, pelvic examination in
women and blood tests. For the treatment of syphilitic cases, the rate will be $2.00 per
injection, and for additional visits for the treatment of gonorrhoea the rate will be
$2.00 per visit. Physicians practising in those areas where there is a full time health
unit are asked to submit their accounts to the Director of the Health Unit, otherwise
the accounts should be sent to the Division of V.D. Control, 2700 Laurel Street, Vancouver.   All accounts must be in triplicate.
DR. GORDON ALEXANDER McCURDY
1907: Born Sydney, Nova Scotia.    Died: Victoria, British Columbia, 1944.
In the death, at the early age of 37, of Dr. Gordon McCurdy, the medical
profession and the citizens of British Columbia have suffered a serious loss.
Dr. McCurdy was a graduate of Dalhousie University in both Arts and Medicine. On completion of his University course in 1933, he did post-graduate
work in Pathology at Glasgow University and returned to Halifax as Assistant
to Dr. Ralph Smith, Provincial Pathologist. In 1937 he was appointed Director
of of the Pathological Department of The Royal Jubilee Hospital in Victoria.
During the next seven years, in spite of impaired health, he was enthusiastic in
building up his own Department, organizing Pathological Conferences and
assisting in the scientific work of the Victoria Medical Society. He qualified
for membership in the American Board of Pathologists and as a fellow of the
American Society of Chemical Pathology. His professional work was characterized by a very high degree of intellectual integrity and in demanding a high
standard of scientific work from himself he predicated the same in his associates. In addition to his his special training, Dr. McCurdy had an unusual
aptitude in correlating clinical medicine with the Pathological and Bacteriological findings.
However skill and judgment in his own work, important as they were, would
not alone have accounted for his success. He had an exceptional facility in
making lasting friendships. He had early learned to follow the advice of
Polonius:
"Those friends thou hast and their adoption tried,
Grapple them to thy soul with hooks of steel."
and the friends of college days remained steadfast and loyal in spite of passing
years and separation.
Dr. McCurdy had few outside interests but those privileged to know him
in his own home quickly realized how deep was the satisfaction he found in
the world of music opened to him by bis gifted wife.
We shall all miss Dr. McCurdy in our daily work and wish for bis guidance
and enthusiasm.
—H. H. Murphy.
Page Fifty-eight MERSALYL B.D
The Standard Mercurial Diuretic
A mercurial preparation is essential for the efficient and rapid
induction of diuresis.
Mersalyl (described in the Addendum 1936 to the B.P. 1932)
is accepted as the standard mercurial diuertic. In common with
all potent drugs, it has some toxic properties, but these are of
little significance as compared with the benefits associated with
its controlled use. A few cases of idiosyncrasy have been reported, but, as has been stated in a report upon the use of intravenous
mercurial diuretics (Lancet, May 8th, 1943, p. 576), 'The occurrence of a few unfortunate reactions is not an indication to withhold the
drug but rather to use care in administering it*.
Mersalyl is indicated principally for the treatment of ascites and
oedema of cardiac and cardio-renal origin and ascites due to
hepatic cirrhosis.
Mersalyl is normally administered by injection for which purpose
it is available as Mersalyl B.D.H. in ampoules. For supplementary
treatment in prolonging the diuresis induced by an injection
Mersalyl B.D.H. is available in tablets for oral administration and
in suppositories for rectal use.
Stocks of Mersalyl B.D.H. are held by leading druggists throughout
the Dominion,  and full  particulars  are  obtainable  from   ....
THE BRITISH DRUG HOUSES (CANADA) LTD.
Toronto Canada
Mrsl/Can/4411 "That's What I Call Rapid Healing!"
AFTER TEN DAYS of Amphojel treatment (with,
of course, an appropriate regime of diet and rest),
x-ray re-examination often reveals complete disappearance of the peptic ulcer niche.f
In addition to promoting rapid healing of the ulcer,
Amphojel offers:
Prompt relief from pain
Fewer recurrences
Superior weight gain during treatment
No alkalosis
AMPHOJEL
"Canada's Original Alumina Gel"
A "Wyethical"
tWOLDMAN, EX., and POLAN, C.G.: Th* value of Colloidal Aluminum Hydroxide in the Treatment
of Peptic Ulcer/ A Review of 407 Consecutive Cases, Am. J. M. Sc. 198:155-164 (Aug.) 1939.
JOHN   WYETH   &   BROTHER   (Canada)   LIMITED,   Walkerville
*i; fad
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It's calls like this, as frequent today as in the
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Verily, G-E customers appreciate today, as never before, the value and
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Many an investment in G-E equipment has
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consistently making good that promise—-despite many wartime handicaps—in G-E equipped hospitals, clinics, and physician's offices
throughout the United States and Canada.
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CjjeMt
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A biologically-standardized product of essential vitamins (A, B, C and D) and minerals (iron and calcium).
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Supplied in boxes of 25 and 50 doses.
230
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Indicated wherever a vitamin-mineral
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FRANK W. HORNER LIMITED
Montreal Canada
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(PreamtiuM' promptly   relieves   pain   and   heartburn
associated with gastric hyperacidity.
T&rcama&Ms often   induces   healing   of   peptic   ulcer
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1
IRON
DURING THE FIRST TWO YEARS
EGG, LIVER,
VEGETABLES,
YEAST, ETC
PABLUM (OR PABENA)
"T^.VftM «®       Dl«- WITH YIAST EXTRAO
••\tf_lttM
e*'
Vl«*
EXTRACT
AND IRON ("D.M.B.")
AGt,Mos. Va     1        2        3        4        5        6        9       12       18       24
WEIGHT, Lbs.     7      9 10        12        14 15 16 19        22        23        25
MILK, Oz.        10       16          18          21
24
26
20
32         32         32
32
MD.HiB.rOz.     1        1          VA        VA
1V_
1%
VA
1         Va          0
0
PABLUM, Oz.     0        0            0           Vs
Va
Va
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Va          1           1
1
IRON DURING
THE
FIRST
' TWO YEARS
During foetal life iron accumulates (in the form of haemoglobin) in the infant's body.
After birth the haemoglobin frequently drops to 50% by the third month, especially
in prematures. Neither breast milk nor cow's milk is capable of offsetting this loss,
as they are deficient in iron. This chart shows that when the carbohydrate and cereal
supplements contain iron, a sizeable margin of safety over the requirements can be
maintained, not only during the important first six months, but throughout the first
two years of life.
More iron than the calculated requirement is needed because some iron is not utilized. In rapidly growing, or poorly nourished infants, and in the presence of infection,
the need for iron may be even greater than is indicated in this chart for normal infants.
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A SAFE QUICK ACTING SEDATIVE, FREE FROM "HANG-OVER"
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When mild continuous sedation is required:
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In excited states: 1 J_ to 3 grains two or three
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Best results are obtained if
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LIQUID >
Average dose for adults: Two to three fluid
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Maximum daily dose for adults: Two fluid
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MODES OF ISSUE
"Noctinal",   J_ gr. CT. No. 352  "JrowT
"Noctinal**, 1*_ gr. CT. No. 353   "SmuT
Both tablets are grooved to
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•one of a series
This pamphlet, written
by Badelard, is thought
to be the first Canadian
publication of a medical
nature.
PHYSICIAN AND SURGEON (1730-1802)
BORN in 1730, in Picardy, Badelard obtained his medical degree in France and
came to Canada as surgeon to the French
troops. During the Battle of the Plains of
Abraham he was made prisoner by a Scot
named Fraser. They became life-long friends.
After the Conquest he settled in Quebec where
he won recognition as a skilful surgeon.
He enrolled in the Canadian Militia in 1775
and the following year was commissioned as
Surgeon to the Quebec Garrison. At the request of Governor Haldimand, he investigated
an outbreak of disease at Baie St. Paul.
Badelard continued this investigation until
1782. He diagnosed the disease as syphilis
and prescribed various forms of mercury in
treating it.
In 1785, a pamphlet giving detailed instructions for the treatment of the malady and
the dosage of mercurial remedies prescribed
was written, by Badelard and circulated by
the Government to all parishes for the instruction of the people.   (See illustration above.)
In 1788, Badelard was conspicuous in supporting a legislative measure to compel any-
WILLIAM
one wishing to practise Physic, Surgery or
Midwifery in Quebec to undergo examinations
and obtain a qualifying Diploma.
Of a somewhat irascible temperament,
Badelard seems later to have gained universal
respect and affection, for at the time of his
death, in 1802, he was followed to his family
burial place at Ancienne Lorette "in spite of
intense cold" by a great throng of clergy and
citizens of ail classes. He bequeathed 12,000
livres (Foundation Badelard) to L'Hopitai
General for rhe purpose of "wintering, lodging
and feeding two poor people". His obituary
describes him as of "a nature faithful, zealous,
charitable, gay and frank . . . the declared
enemy of hypocrisy".
The example set by men like Badelard in
helping to establish a sound foundation for
the practice of medicine
in Canada inspires this
organization to maintain
with unceasing vigilance
its policy—Therapeutic
Exactness and Pharmaceutical Excellence.
& COMPANY LTD.
THE SYMBOL OF
PHARMACEUTICAL
EXCELLENCE
Manufacturing Pharmaceutists
727-733   KING   STREET   WEST,   TORONTO
185*- 1944
ESTABLISHED 1854 LINKS IN THE CHAIN OF TREATMENT
lORYPHEDRINE
IICATIONS:—    GRIPPE,   CORYZA,   RHINITIS,   SINUSITIS,   TRACHEITIS
ILT DOSE:- ONE TO FOUR TABLETS PER DAY:- IN CONTAINERS OF 20, 100, 500 AND 1000 TABLETS
OLUSEPTAZINE
WITH
EPHEDRINE
cations:— Nasal Congestion with Obstruction, Coryza, Acute Rhinitis, Nasopharyngitis
LIED    BY   DROFPER   TUBE,    ATOMIZER    OR    SWAB:-   IN    BOTTLES    OF   30   C.C.    AND    250    C.C.
GONACRM
DICATIONS:-    ORAL   ANTISEPSIS,   TONSILLITIS,   PHARYNGITIS
OW PASTILLE TO DISSOLVE SLOWLY IN THE MOUTH:- SUPPLIED IN BOXES OF 20 AND 40 PASTILLES
ASTIUES
LI   MITED—  MONTREAL MILK -
Gonadal Vital
FOOD FOR VICTORY
Milk is accepted as the most valuable protective
food because it surpasses all others in supplying
vitamins, minerals, and high quality proteins that
build and maintain sound physical fitness. No
wonder our fighting forces are among the best fed
in the world—their milk consumption is exceptionally high—and no wonder Canada's home front,
too, is by far the best fed!
A quart of milk (4 glasses) gives the following
percentages of your DAILY FOOR NEEDS.
Iron  16%
Vitamin C*% 16%
Energy  22%
Vitamin B 28%
Calcium
* Values Variable.
Vitamin A 37%
Protein ,49%
Vitamin G 79%
Phosphorus    69%
 100% MATURITY...
THE BULLETIN
of the Vancouver Medical Association is now in
its 21st year—strong, vigorous, and efficient.
It has been the privilege of Georgia Pharmacy
to grow beside it, year by yearMWe hope to
continue to share your reflected glory.
Phone
MArine 4161
j£**&L *& Jitmd**»\
GEORGIA PHARMACY
13 th Ave. and Heather St.
Exclusive Ambulance  Service
FAirmont 0080
PRIVATE AMBULANCES AND INVALID COACHES
WE SPECIALIZE  IN AMBULANCE SERVICE  ONLY
J. H. C___I_LIN
W.  L.  BERTRAND ■pi
Hi
*
New Westminster, B. C.
Uor the treatment of
NEUROPSYCHIATRIC
DISORDERS
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New "Westminster, B. C.
New Westminster 288
or 721 Medical-Pental Building, Vancouver, B. C.
PAcific 7823 PAciftc 803*
»_7

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